179397 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 363558 Page 1 of 1
ONE CIVIC SQUARE TAMRA ROSE
CARMEL, INDIANA 46032 CHECK AMOUNT: $30.00
5911 SILAS MOFFITT WAY
CARMEL IN 46033 CHECK NUMBER: 179397
CHECK DATE: 11/11/2009
DEPARTMENT! ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1041 4358400 350287 30.00 REFUNDS AWARDS INDE
v
ACTIVITY REFUND RECEIPT
Receipt 350287
Payment Date: 11/02/09
Household 3667
Monon Center Tamra Rose Hm Ph: (317)844 -2758
Carmel IN 46032 5911 Silas Moffitt Way Wk Ph: (317)
Carmel IN 46033 Cell Ph: (317)345 -6057
tjrose06 @yahoo.com
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 30.00
Enrollee Name: Isabella Beckler Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 296370 -03 Zumba Kills 0.00 0.00 0.00 0.00 0.00
Enrollment bate: 10/15/2009 (Cancelled)
Primary Instructor: Tumble Time
Class Location: Fitness Studio B Class Dates: 11/05/2009 to 11/19/2009
Monon Center 4-OOP to 4:45P
Th
Carmel, IN 46032 Scheduled Sessions: 3
(317)848 -7275
Cancel Reason: low enrollment
G/L Code Description Account Number Cs_t_Cntr Description Account_Numb_er _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 CREDIT HOUSEHOLD BALANCE 1.00
Processed on 11/02/09 10:21:00 by LVA FEES CHANGED ON CANCELLED ITEMS 30.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 30.00
NEW NET CREDIT HOUSEHOLD BALANCE 1.00
Refund of 30.00 Made By REFUND FINAN With Reference low enrollment
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
issued cash or credit card refunds.
Authorized
Sign a re Cfate Authorized Signature Date
q;qco NOV 0 4 2009
ZY.
Page 1
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.
Rose, Tamra Terms
5911 Silas Moffitt Way Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/2/09 350287 Refund 30.00
Total 30.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
Rose, Tamra Allowed 20
'6911 Silas Moffitt Way
Carmel, IN 46033
In Sum of
30.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1047 350287 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
5 -Nov 2009
Signature
30.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund