176437 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: T356576 Page 1 of 1
ONE CIVIC SQUARE LESLIE SIMICH
CARMEL, INDIANA 46032 14048 SEDONA DRIVE CHECK AMOUNT: $52.00
o CARMEL IN 46032
CHECK NUMBER: 176437
CHECK DATE: 8/19/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 312573 52.00 REFUNDS AWARDS TNDE
ACTIVITY REFUND RECEIPT
Receipt 31257,3 1 Y9
Payment Date: 0713;1!2009
Household A 2.7758
Home Phone: (317)815 -5916 AUG! U 4 200
Work Phone:
J=L y e
LESLIE SIMICH Moron Center
14048 SEDONA DRIVE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
CANCELLATION Refund Of 52.00
Enrollee Name: Victoria Simich Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 196371 -04 Cheerleading 0.00 0.00 0.00 0.00 0.00
Enrollment Date: 06/11/2009 (Cancelled)
Primary Instructor: Tumble Time
Class Location: Party Rooms A B Class Dates: 08/05/2009 to 08/26/2009
Monon Center 4:OOP to 4:45P
W
Carmel, IN 46032 Scheduled Sessions: 4
(317)848 -7275
Cancel Reason: IOW enrollment
G /LCode Description Accoun Number Cst_Cntr Account-Numbe ___Amo_unt
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 52.00 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 07/31/09 09.30.20 by LVA FEES CHANGED ON CANCELLED ITEMS 52.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
NET AMOUNT FROM CANCELLED ITEMS
TOTAL AMOUNT AMOUNT REFUNDED 52.00
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 52.00 Made By REFUND FINAN With Reference low enrollment
Page 1
ACTIVITY REFUND RECEIPT
Receipt 312573
Payment Date: 07/3112009
Household 27758
All refunds are subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
A issued No cash or credit card refunds.
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orized SignalAre 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.
Terms
Simich, Leslie
Date Due
14048 Sedona Drive
Carmel, IN 46032
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
52.00
7/31109 312573 Refund
Total 52.00
I hereby certify that the attached invoice(s), or bills) 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.
Simich, Leslie Allowed 20
14048 Sedona Drive
Carmel, IN 46032
In Sum of$
52.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 312573 4358400 52.00 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
13 -Aug 2009
Signature
52.00 Accounts Payable Coordinator
Cost distribution ledger classification it Title
claim paid motor vehicle highway fund