173424 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 362931 Page 1 of 1
ONE CIVIC SQUARE JESSE LI
CHECK AMOUNT: $146.64
CARMEL, INDIANA 46032 11947 TARRYNOT LANE
CARMEL IN 46033
CHECK NUMBER: 173424
CHECK DATE: 6/10/2009
D EPARTMENT A CCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1047 4358400 146.64 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 262151
Payment Date: 05/22/2009
Household 18413
Home Phone: (317)818-3996 T rf K r 3 ,,7 r
Work Phone: t pmt
MAY 2 6 2009 LJ
JESSE LI Monon Center B— Y:
11947 TARRYNOT LANE Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 146.64
Pass Holder: Jesse Li Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #51807 93.36 0.00 93.36 0.00 0 00
Valid Dates: 12/31/2008 to 12/31/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Dis count S ales Tax Total Fee
Yearly Fitness Adult 93.36 1.00 0.00 0.00 93.36
Cancel Reason: Injured his foot
G/L Code Description Account Number Cst Cntr Descri Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 146.64 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 05/22/09 08:58:57 by RDG FEES CHANGED ON CANCELLED ITEMS 14664-
DISCOUNT APPLIED AGAINST CANCELLED FEES O 0 o0
SALES TAX CHARGED ON CANCELLED FEES 01-
NET AMOUNT CANCELLED ITEMS 146.64
TOTAL AMOUNT REFUNDED 146.64
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 146.64 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.
<:I�uthorized Signature Date Authorized Signature Date
L Y 7 D (413-S"
Page 1
�JP 5;,.
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.
Li, Jesse Terms
11947 Tarrynot Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/22/09 262151 Refund 146.64
Total 146.64
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.
Li, Jesse Allowed 20
11947 Tarrynot Lane
Carmel, IN 46033
In Sum of
r* 146.64
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 262151 4358400 146.64 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
4 -Jun 2009
T
Signature
146.64 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund