169056 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: T362567 Page 1 of 1
ONE CIVIC SQUARE ROBERT LUHRS
CHECK AMOUNT: $335.32
CARMEL, INDIANA 46032 3666 WALDEN PLACE
CARMEL IN 46033
CHECK NUMBER: 169056
CHECK DATE: 2/17/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 222754 335.32 REFUNDS AWARDS INDE
I
i
r PASS REFUND RECEIPT
Receipt 222754
Payment Date: 01/27/2009
Household 42695
Home Phone: (317)566 -9898
Work Phone:
ROBERT LUHRS Monon Center
3666 WALDEN PLACE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 167.66
Pass Holder: Robert Luhrs Fees +Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #14995 72.34 0.00 72.34 0.00 0.00
Valid Dates: 10/09/2008 to 10/09/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount S ales Tax Total Fee
Yearly Fitness Adult 72.34 1.00 0.00 0.00 72,34
Cancel Reason: Not able to use with family obligations.
CANCELLATION Refund Of 167.66
Pass Holder: Tracy Luhrs Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #14996 72.34 0.00 72.34 0.00 0.00
Valid Dates: 10/09/2008 to 10/09/2009 Pass Cancellation)
Fee Details: Fee Descri Amount Count Discount Sales Tax Total Fee
Yearly Fitness Adult 72.34 1.00 0.00 0.00 72.34
Cancel Reason: Not able to use with family obligations.
G/L Code Descri Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 335.32 DR
The REVENUE account was'bEBITED 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 01/27/09 13:59:18 by CRS FEES CHANGED ON CANCELLED ITEMS 335.32
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NNETAMOUNT °FROM CANCELLED;ITEMS;.`: _y 33532=
TOTAL`AMOUNT:REFUNDED1ir,;. =.335:32_
Page 1
r PASS REFUND RECEIPT
Receipt 222754
Payment Date: 01/27/2009
Household 12695
NEW NET HOUSEHOLD BALANCE 0.00
i
Refund of 335.32 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.
Authorized Signature Date Authorized Signature Date
Page 2
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.
Luhrs, Robert Terms
3666 Walden Place Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1127109 222754 Refund 335.32
Total 335.32
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Luhrs, Robert Allowed 20
3666 Walden Place
Carmel, IN 46033
In Sum of
�r
335.32
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 222754 4358400 335.32 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 -Feb 2009
Signature
335.32 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund