174037 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 362974 Page 1 of 1
ONE CIVIC SQUARE RUSHINI SANDRASEGARAN
CARMEL, INDIANA 46032 11760 WINDPOINTE PASS CHECK AMOUNT: $60.00
CARMEL IN 46033
CHECK NUMBER: 174037
CHECK DATE: 6124/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
.1047 4358400 60.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
r
Receipt 264909.
Payment Date: 05/28/2009
Household 5477 Y f. F
Home Phone: (-3_1'7)846 -4903 s s?
Wbrk Phone:
J UN D 8 1o09 j
RUSHINI SANDRASEGARAN Monon Center
11760 WINDPOINTE PASS Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 60.00
Enrollee Name: Nicole Segaran Fees Tax Discount Prey Paid Cur Paid Amount Due
Activity Number. 196398 -01 Poetry Write Up 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 05/13/2009 (Cancelled)
Primary Instructor CCPR Staff
Class Location: Art Studio Class Dates: 06101/2009 to 06/29/2009
Monon Center 12:OOP to 1:OOP
M
Carmel, IN 46032 Scheduled Sessions: 5
(317)848 -7275
Cancel Reason: low enrollment
GAL 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 60.00 OR
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 05/28/09 18:10:28 by CNA FEES CHANGED ON CANCELLED ITEMS 60_(M-
DISCOU14T APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NETAMOUNTFROM CANCELLED ITEMS 60.00
TOTAL AMOUNT REFUNDED 60.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 60.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
4 Receipt 264909
Payment Date: 05/2812009
Household M 5477
Al 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.
uthorized 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.
Sandrasegaran, Rushini Terms
11760 Windpointe Pass Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5128109 264909 Refund 60.00
Total 60.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Sandrasegaran, Rushini Allowed 20
11760 Windpointe Pass
Carmel, IN 46033
In Sum of
60.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT#fTITLE AMOUNT Board Members
Dept
1047 264909 4358400 60.00 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
60.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund