HomeMy WebLinkAbout175946 08/06/2009 CITY OF CARMEL., INDIANA VENDOR: 363198 Page 1 of 1
ONE CIVIC SQUARE BRIAN WALBORN CHECK AMOUNT: $130.85
CARMEL, INDIANA 46032 3776 POWER DRIVE
CARMEL IN 46033 CHECK NUMBER: 175946
CHECK DATE: 8/6/2009
DEP ACCOUNT PO NUMBER INV OICE NU MBER AMOUNT DESCRIPT
1047 4358400 308989 130.85 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 308989
Payment Date: 07/26/2009
Household 12957
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 130.85'`;
Pass Holder: Brian WdII Orn Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #57453 109.15 0.00 109.15 0.00 0.00
Valid Dates: 02/10/2009 to 02/10/2010 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 109.15 1.00 0.00 0.00 109.15
Cancel Reason: Moving
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 130.85 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 07/26/09 09:36:31 by MS FEES CHANGED ON CANCELLED ITEMS 130.85
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NETr AMOUNT FROM CANCELLED:IT.EMS 130.85
TOTAL:AMOUNT REFUNDED 130 885
L�7 —loo 0 -0o J oo NEW NET HOUSEHOLD BALANCE 0.00
Refund of 130.85 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 cash or credit card refunds.
7 12 7 D
Authorized Signature Date Authorized Signature date
7 7 Page 1
4
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, r ate per hour, number of units, price per unit, etc.
Payee Purchase Order No.
Terms
Walbo
3778 Peer Drive Date Due
Carmel, IN 46033
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
130.85
7/26/09 308989 Refund
Total 130.85
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 !P6WE-R Dl
Carmel, IN 46033
In Sum of
130.85
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #fTITLE AMOUNT Board Members
Dept
1047 308989 4358400 130.85 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
30 -Jul 2009
&hDlm f-ry)Qj-(
Signature
130.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund