173096 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 362912 Page 1 of 1
ONE CIVIC SQUARE SARAH WORTH CHECK AMOUNT: $90.00
CARMEL, INDIANA 46032 2201 EMERALD PINES LANE
WESTFIELD IN 46074 CHECK NUMBER: 173096
CHECK DATE: 5/27/2009
DEPAR ACCOU PO NUMBER INVOICE NUMBER A MOUNT D ESCRIPTION
1047 4358400 257704 90.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
Receipt 257704
Payment Date: 05/12/2009 r,
Household 25618
Home Phone: (317)867 -2528
Work Phone: MAY 2 1 2009
D:
SARAH WORTH Monon Center
2201 EMERALD PINES LANE Carmel IN 46032
WESTFIELD IN 46074
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Refund Details
Oria Ball Refund New Bat
Module: Activity Registration 90.00 90.00 0.00
GIL 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 90.00 DR
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 90.00
Processed on 05112/09 13:30:28 by CNA NEW REFUND AMOUNT 90.00
TOTAL REFUNDABLE AMOUNT 90.0o
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 90.00 Made By REFUND FINAN With Reference low enrollment 801b(� �c9a
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.
549IC9 le L
Authorized Signature Date Authorized Signature Date
o
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.
Worth, Sarah Terms
2201 Emerald Pines Lane Date Due
Westfield, IN 46074
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/12/09 257704 Refund 90.00
Total 90.00
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.
Worth, Sarah Allowed 20
2201 Emerald Pines Lane
Westfield, IN 46074
In Sum of
90.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 257704 4358400 90.00 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
21 -May 2009
Signature
Is 90.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund