175048 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 363070 Page 1 of 1
ONE CIVIC SQUARE AMY NICHOLS
CARMEL, INDIANA 46032 13436 SHAKAMAC DRIVE CHECK AMOUNT: $60.00
CARMEL IN 46032
CHECK NUMBER: 175048
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER I NVOICE N AMOUNT DESCRIPTION
1047 4358400 60.00 PARKS DEPARTMENT REFU
.p
c
3
r ACTIVITY REFUND RECEIPT
Receipt 292068
Payment Date: 07/01/2009
Household 27123
Home Phone: (317)571 -1935
Work Phone: t v uL O 7 7009 J
AMY NICHOLS Monon Center
13436 SHAKAMAC DRIVE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 60.00
Enrollee Name: Lizzie Nichols Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 195285 -03 Kickstart to Kinderg 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/27/2009 (Cancelled)
Primary Instructor: ABCs of Phonics
Class Location: Program Room B Class Dates: 07/06/2009 to 08/03/2009
Monon Center 9:30A to 10:30A
M
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: low enrollment
G/L Co Description Account Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 60.00 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 07/01/09 13:49:33 by MML FEES CHANGED ON CANCELLED ITEMS 60.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM'CANCELLED ITEMS 60.00
TOTAL AMOUNT.REFUNDED 60.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 60.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 292068
Payment Date: 07/01/2009
Household 27123
All refunds are bje t to State Board of Accounts cl im procedure and may take 4 -6 weeks to process. A check will be
issued ca or edit r efunds.
71/0
Au d gn re '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.
Nichols, Amy Terms
13436 Shakamac Drive Date Due
Carmel, IN 46032
4'
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/1/09 Refund 60.00
Total 60.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Nichols, Amy Allowed 20
13436 Shakamac Drive
Carmel, IN 46032,
In Sum of
60.00
ON ACCOUNT OF APPROPRIATION FOR
104 .Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 292068 4358400 60.00 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
16 -Jul 2009
V
Signature
60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund