173925 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 362969 Page 1 of 1
,J ONE CIVIC SQUARE MARK LUSHELL CHECK AMOUNT: $125.00
S,.ro CARMEL, INDIANA 46032 12110 ELLINGWOOD DRIVE
''k_o _g'o CARMEL IN 46032 CHECK NUMBER: 173925
CHECK DATE: 6/24/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 43.58400 125.00 PARKS DEPARTMENT REFU
<1
i
ACTIVITY REFUND RECEIPT
`t
Receipt 264558
Payment Date: 05/27/2009
Household 6699
Heme Phone: (317)873 -9138 r',; JUN 0 8 2009
Work Phone:
MARK LUSHELL Monon Center
12110 ELLINGWOOD DR. Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund OF 125.00
Enrollee Name: Cooper Lushell Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number. 195255 -01 Train the Brain 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/02/2009 (Cancelled)
Primary Instructor. Int Talent Academy
Class Location: Program Room B Class Dates: 06/04/2009 to 07/30/2009
Monon Center 11:30A to 12:15P
Th
Carmel, IN 46032 Scheduled Sessions: 8
(317)848 -7275
Skip Days 07/02/2009
Cancel Reason: low enrollment
G/L Code Description Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Aoct CNTRL Control Account (AP) Enter Control Acct here 125.00 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 05/27/09 17:12:10 by CNA FEES CHANGED ON CANCELLED ITEMS 125.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS 125.00-
TOTAL AMOUNT REFUNDED 125.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 125.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 264558
Payment Date: 05/27/2009
Household 6699
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.
aj-&,v, a -7/o 9 R� s
Authori ed Signature Date Authorized Signature Date
q qoo,
Page 2
ACCOUNTS PAYABLE VOUCHER
u
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.
Lushell, Mark Terms
12110 Ellingwood Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/27/09 264558 Refund 125.00
Total 125.00
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.
Lushell, Mark Allowed 20
12110 Ellingwood Dr
Carmel, IN 46032
In Sum of
J
125.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept
1047 264558 4358400 125.00 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
18 -Jun 2009
Signature
125.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund