HomeMy WebLinkAbout176491 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 363198 Page 1 of 1
ONE CIVIC SQUARE BRIAN WALBORN
CHECK AMOUNT: $53.26
�,`a CARMEL, INDIANA 46032 3778 POWER DRIVE
*t.o� CARMEL IN 46033 CHECK NUMBER: 176491
CHECK DATE: 8/1912009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 322207 53.26 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 322207
Payment Date: 08/10/2009
Household 12957 u rr 2009
j
Home Phone: (317)670 -5508
Work Phone:
BRIAN WALBORN Monon Center
3778 POWER DRIVE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 53.26
Pass Holder: Heather Walborn Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #43903 186.74 0.00 186.74 0.00 0.00
Valid Dates: 10/30/2008 to 10/30/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 186.74 1.00 0.00 0.00 186.74
Cancel Reason: (health
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 53.26 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 08/10/09 15:11:29 by MAK FEES CHANGED ON CANCELLED ITEMS 53.26
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT: FROM CANCELLED ITEMS. 53.26
TOTAL AMOUNT.REF.UNDED 53.26
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 53.26 Made By REFUND FINAN With Reference
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 ash or credit card refunds.
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Auth rized Signature Dale Authorized Signature Date
GL- y- lo() OD L`35 SC oo
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.
Walborn, Brian Terms
3778 Power Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8110109 322207 Refund 53.26
Total 53.26
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.
Walborn, Brian Allowed 20
3778 Power Drive
Carmel, IN 46033
In Sum of
53.26
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 322207 4358400 53.26 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
13 -Aug 2009
Signature
53.26 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund