HomeMy WebLinkAbout177724 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363371 Page 1 of 1
s ONE CIVIC SQUARE JO ANN NIEHAUS CHECK AMOUNT: $250.00
CARMEL, INDIANA 46032 5874 KIAWAH COURT
CARMEL IN 46033 CHECK NUMBER: 177724
CHECK DATE: 9/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A DESCRIPTION
1047 4358400 338637 250.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 338637 g W
Payment Date: 09/16/2009 '1
Household 9649 2009
Home Phone: (317)569 -7189
JO ANN NIEHAUS Monon Center
5874 KIAWAH COURT Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pact Details
CANCELLATION Refund Of 250.00
Pass Holder: Jo Ann Niehaus Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly GF Res Unli (YGFRU), #47474 0.00 0.00 0.00 0.00 0.00
Valid Dates: 11/29/2008 to 11/29/2009 Pass Cancellation)
Cancel Reason: cancel medical
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 250.00 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 09/16/09 10:51:22 by CEK FEES CHANGED ON CANCELLED ITEMS 250.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
�NET'AMOUNT�'FROM�.CANCELLED ITEMS„ 250:00-
TOTALrAMOUNTREFUNDED A
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 250.00 Made By REFUND FINAN With Reference medical
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued. No cash or credit card refunds.
Authorized Signature Date Authorized Signature Date
'4�.4vv. Sao. 1 435g�fod f
Page 1
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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.
Niehaus, Jo Ann Terms
5874 Kiawah Court Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/16/09 338637 Refund 250.00
Total 250.00
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
1
Voucher No. Warrant No.
;r Niehaus, Jo Ann Allowed 20
5874 Kiawah Court
t Carmel, IN 46033
In Sum of
250.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 338637 4358400 250.00 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
24 -Sep 2009
Signature
250.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund