172019 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 362805 Page 1 of 1
0 ONE CIVIC SQUARE MARINA ROLBIN CHECK AMOUNT: $38.00
CARMEL, INDIANA 46032 1445 QUEENSBOROUGH DR.
M CARMEL IN 46033 CHECK NUMBER: 172019
CHECK DATE: 4/29/2009
DEPARTMENT AC COUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 251702 38.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 251702 t .g g g y
Payment Date: 04/20/2009
Household 17721 APR 2 2
Home Phone: (317)815 -4626 Z��9!
Work Phone:
13Y
MARINA ROLBIN Monon Center
1445 QUEENSBOROUGH DR. Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 38.00
Enrollee Name: David Rolbin Fees Tax Discount Prey Paid CUT Paid Amount Due
Activity Number. 195002 -01 Lil' Dragon Taekwo 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/01/2009 (Cancelled)
Primary Instructor. Indy Taekwondo
Class Location: Gymnasium C Class Dates: 05/07/2009 to 06/25/2009
Monon Center 4:OOP to 4:30P
Th
Carmel, IN 46032 Scheduled Sessions: 8
(317)848 -7275
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Indy Tae Kwon Do Lit 7.00 1.00 0.00 0.00 7.00
Cancel Reason: time Conflict
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 38.00 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 04/20/09 08:31:04 by CNA FEES CHANGED ON CANCELLED ITEMS 45.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 7.00
NET AMOUNT FROM CANCELLED ITEMS TOTAL AMOUNT AMOUNT REFUNDED 38.00
NEW NET HOUSEHOLD BALANCE 0.00
Page 1
ACTIVITY REFUND RECEIPT
4 Receipt 251702
Payment Date: 04/20/2009
Household 17721
Refund of 38.00 Made By REFUND FINAN With Reference time conflict
Rewards Points refunded on this receipt: 0.70
Household Reward Point Balance: 920
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.
Q &c, L I ao 09
Authorized Signature Date Authorized Signature Date
y31)
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.
Terms
Robin, Marina
1445 Queensborough Dr Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
38.00
4/20/09 251702 Refund
Total 38.00
I 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.
Rolbin, Marina Allowed 20
1445 Queensborough Dr.,
Carmel, IN 46033
In Sum of
38.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1047 251702 4358400 38.00 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
22 -Apr 2009
Signature
38.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund