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Home My WebLink About178754 10/28/2009 *f CITY OF CARMEL, INDIANA VENDOR: 363449 Page 1 of 1 ONE CIVIC SQUARE SAMPURNA KUCHAKULLA CHECK AMOUNT: $253.91 CARMEL, INDIANA 46032 13936 WASHITA COURT CARMEL IN 46032 CHECK NUMBER: 178754 CHECK DATE: 10/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1047 4358400 342718 253.91 REFUNDS AWARDS INDE z'�; PASS REFUND RECEIPT Receipt 342718 A n- R" F Payment Date: 10/07/2009 Household 1105 Home Phone: (317)569 -1004 0 C T 3 2009 Work Phone: (317) 1 h.0 4 Al. ci i GGiSf ii till id Bfbi! ®f SAMPURNA KUCHAKULLA Monon Center 13936 WASHITA COURT Carmel IN 46032 CARMEL IN 46032 Phone: (317)848 -7275 Fed Tax ID #35- 6000972 Pass Details CANCELLATION Pass Holder: Sampurna Kuchakulla Fees Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Yly GF Res Unli (YGFRU), #22373 250.00 0.00 250.00 0.00 0.00 Valid Dates: 03/20/2008 to 03/20/2009 Pass Cancellation) Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee Yearly GF Res Unlimi 250.00 1.00 0.00 0.00 250.00 Cancel Reason: moving CANCELLATION Refund Of 253.91 Pass Holder: Sampurna Kuchakulla Fees +Tax Discount Prev Paid Cur Paid Amount Due Pass Type: Yly GF Res Unli (YGFRU), #81286 21.09 0.00 21.09 0.00 0.00 Valid Dates: 09/09/2009 to 09/09/2010 Pass Cancellation) Fee Details: Fee Description Amount Count Discount Sales Tax Total Fe Yearly GF Res Unlimi 21.09 1.00 0.00 0.00 21.09 Cancel Reason: moving G/L Code Description Account Number Cst Cntr Description Account Number Amount 999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 253.91 DR The REVENUE account was DEBITED and the CONTROL account was CREDITED on the day of the refund. Finance will have to DEBIT the CONTROL account for the amounts listed above after the checks have been written to the customers. PREVIOUS NET HOUSEHOLD BALANCE 0.00 Processed on 10/07/09 06:09:10 by RDG FEES CHANGED ON CANCELLED ITEMS 253.91 DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00 SALES TAX CHARGED ON CANCELLED FEES 0.00 ,NET AMOUNT FROMCANCELLEDITEMS 253:91 'TOTAL'dAMOUNTREFUNDED 253191,`,`','. Page 1 PASS REFUND RECEIPT Receipt 342718 Payment Date: 10/07/2009 Household 1105 NEW NET HOUSEHOLD BALANCE 0.00 Refund of 253.91 Made By REFUND FINAN With Reference All refunds are subject to S aVred counts claim procedure and may take 4 -6 weeks to process. A check will be C Jssu o ash or credit r jAu orized Si gnatur Date Authorized Signature Date Page 2 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Kuchakulla, Sampurna Terms 13936 Washita Court Date Due Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/7/09 342718 Refund 253.91 Total 253.91 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20_ Clerk- Treasurer Voucher No. Warrant No. Kuchakulla, Sampurna Allowed 20 13936 Washita Court Carmel, IN 46032 In Sum of 253.91 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept 1047 342718 4358400 253.91 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 22 -Oct 2009 Signature 253.91 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund