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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. g �a o 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