172917 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 362804 Page 1 of 1
ONE CIVIC SQUARE ANDREA LIEBROSS CHECK AMOUNT: $15.00
CARMEL, INDIANA 46032 12519 GLENDURGAN DR.
CARMEL IN 46032 CHECK NUMBER: 172917
CHECK DATE: 5/27/2009
DEPA AC PO NUMBER INVO NUMB AMOUNT DESCRIP
1047 4358400 252279 15.00 REFUNDS AWARDS ZNDE
ACTIVITY REFUND RECEIPT
Receipt 252279
Payment Date: 04/22/2006 MAY 1 2009
Household 3842
Home Phone: (317)705 -1602
Work Phone: r
ANDREA LIEBROSS Monon Center
12519 GLENDURGAN DR. Carmel IN 46032
CARMEL IN 46032
Phone. (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 15.00
Enrollee Name: Brett Liebross Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number 399064-11 Family Field Day 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 01/3012009 (Cancelled)
Primary Instructor. CCPR Staff
Class Location: West Park Field Class Dates: 04/26/2009 to 04126/2009
West Park 12-30P to 2:30P
2700 W. 116th St. Su
Carmel, IN 46032 Scheduled Sessions: 1
(317)848 -7275
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 Aocount (AP) Enter Control Acct here 15.00 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 04122/09 09:01:55 by CNA FEES CHANGED ON CANCELLED ITEMS 15,00_
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NETAMOUNT !FROM CANCELLED ITEMS" 15.00
TOTAL AMOUNT REFUNDED:: 15.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 15.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 252279
Payment Date: 04/22/2009
Household 3842
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
is Ned. No cash or credit card refunds.
Authorized Signature Date Authorized Signature Date
qx Ifa)
Rm
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.
Liebross, Andrea Terms
12519 Glendurgan Dr Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/22/09 252279 Refund 15.00
Total 15.00
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.
Liebross, Andrea Allowed 20
12519 Glendurgan Dr
Carmel, IN 46032
In Sum of
15.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 252279 4358400 15.00 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 15.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund