167694 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 362349 Page 'I of 1
Q i ONE CIVIC SQUARE WILLIAM SCARPINO
CARMEL, INDIANA 46032 5022 SURREY LANE CHECK AMOUNT: $309.21
CARMEL IN 46033 CHECK NUMBER: 167694
CHECK DATE: 1!712009
DEPARTMENT ACCOUN PO NUMB INVOI NUMBER AMOUNT DESCRIPTION
1047 4358400 207075 309.21.REFUNDS AWARDS INDE
a x PASS REFUND RECEIPT
Receipt 207075 L- tlt� °D
Payment Date: 12/07/2008 DE!C I i
Household 6841 C 1 9 2008
Home Phone: (317)580 -1894
Work Phone: (317)817 -5160
WILLIAM SCARPINO Monon Center
5022 SURREY LN Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION
Pass Holder: William Scarpino Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #2539 240.00 0.00 240.00 0.00 0.00
Valid Dates: 05/26/2007 to 05/26/2008 Pass Cancellation)
Fee Detaiis: Fee Description Amount C ount Discount Sales Tax Total Fee
Yearly Fitness Adult 240.00 1.00 0.00 0.00 240.00
Cancel Reason: Economy
CANCELLATION Refund Of 309.21
Pass Holder: William Scarpino Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Hh Res (YFTHR), #25726 350.79 0.00 350.79 0.00 0.00
Valid Dates: 05/27/2008 to 05/27/2009 Pass Cancellation)
Fee Details: Fee Descri Amount Cou Discount Sales Tax Total Fee
Yearly Fitness House 350.79 1.00 0.00 0.00 350.79
Cancel Reason: Economy
CANCELLATION
Pass Holder: Nick Scarpino Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Ylly FT Hh Res A (YFTHRADD), #25727 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/27/2008 to 05/27/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly FT Household 0.00 1.00 0.00 0.00 0.00
Cancel Reason. Economy
Page 1
PASS REFUND RECEIPT
Receipt 207075
Payment Date: 12/07/2008
Household 6841
CANCELLATION
Pass Holder: Nick Scarpino Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Yth Res (YFTYR), #4925 150.00 0.00 150.00 0.00 0.00
Valid Dates: 05/31/2007 to 05/31/2008 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly Fitness Youth 150.00 1.00 0.00 0.00 150.00
Cancel Reason: Economy
CANCELLATION
Pass Holder: Sommer Scarpino Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Hh Res A (YFTHRADD), #25728 0.00 0.00 0.00 0.00 0.00
Valid Dates: 05/27/2008 to 05/27/2009 Pass Cancellation)
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Yearly FT Household 0.00 1.00 0.00 0.00 0.00
Cancel Reason: Economy
G/L 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 309.21 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 12/07/08 10:46:00 by RDG FEES CHANGED ON CANCELLED ITEMS 309.21
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET= AMOUNT. FROM•CANCEL'L`•ED:ITEMS
TOTALsA. MOUNTREFUNDED
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 309.21 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 cre it card refunds.
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Authorized Signature Date Authorized Signature Date
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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.
Scarpino, William Terms
5022 Surrey Lane Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number
or note attached invoice(s) or bill(s)) Amount
309.21
1217108 207075 Refund
Total 309.21
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.
Scarpino, William Allowed 20
5022 Surrey Lane
Carmel, IN 46033
In Sum of
309.21
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 207075 4358400 309.21 I 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
19 -Dec 2008
Signature
309.21 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund