168678 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: T362481 Page 1 of 1
ONE CIVIC SQUARE JANE ROHRABAUGH CHECK AMOUNT: $30.00
CARMEL, INDIANA 46032 10807 EAST LAKESHORE DRIVE
CARMEL IN 46032 CHECK NUMBER: 168678
CHECK DATE: 2/4 /2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 30.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 219735
Payment Date: 01/15/2009
Household 4569
Home Phone: (317)818 -3540
Work Phone:
JANE ROHRABALIGH Monon Center
10807 E. LAKE SHORE DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 30.00
Enrollee Name: Ava Rohrabaugh Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 396312 -01 After School Dodgeba 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 12/16/2008 (Cancelled)
Primary Instructor: CCPR Staff
Class Location: Gymnasium C Class Dates: 02/02/2009 to 03/23/2009
Monon Center 4:OOP to 5:OOP
M
Carmel, IN 46032
(317)848 -7275 Scheduled Sessions: 8
Cancel Reason: Broke Leg
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 30.00 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 01/15/09 13:18:05 by LVA FEES CHANGED ON CANCELLED ITEMS 30.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 30.00-
TOTAL AMOUNT REFUNDED 30.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 30.00 Made By REFUND FINAN With Reference broken leg
Page 1
ACTIVITY REFUND RECEIPT
Receipt 219735
Payment Date: 01/15/2009
Household 4569
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.
y 1//s //It /0 c7
Authorize�Sin ur e date Authorized Signature Date
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Page 2
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
must show; kind of service, where performed, dates service rendered, by
properly itemized rice per unit, etc.
An invoice of bill to be er of hours, rate per hour, number of units, p
whom, rates per day, num
Purchase Order No.
Payee Terms
Rohrabaug
h, Jane Date Due
10807 E Lake Shore Dr
Carmel, IN 46032
A
Description
Amount
Invoice or bill(s)) 30.00
Invoice (or note attached invoices)
Date Number
Date 219735 Refund
1/15/09
Total 30.00
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
20_. Clerk- Treasurer
Voucher No. Warrant No.
Rohrabaugh, Jane Allowed 20
10807 E Lake Shore Dr
Carmel, IN 46032
In Sum of
30.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 219735 4358400 30.00 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
2 -Feb 2009
Signature
30.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund