174500 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 363039 Page 1 of 1
t- ONE CIVIC SQUARE CYNTHIA SIMMONS CHECK AMOUNT: $36.00
s4�ia CARMEL, INDIANA 46032 12519 WINDSOR DRIVE
CARMEL IN 46033 CHECK NUMBER: 174500
CHECK DATE: 7/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
1046 4358400 36.00 PARKS DEPARTMENT REFU
ACTIVITY REFUND RECEIPT
Receipt 286794,
Payment Date: 06/25/2009
Household 17499
Home Phone: (317)566 -9341 JUN 26 J
Work Phone: (317)566 -9622
CYNTHIA SIMMONS Wood Brook Elemental
12519 WINDSOR DRIVE 4311 East 116th Street
CARMEL IN 46033 Carmel IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Enrollment Details
ROSTER CHANGE Refund Of 36.00
Enrollee Name: Connor Simmons Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 476003 -03 Outdoor Explorers 89.00 0.00 75.00 14.00 0.00
Enrollment Date: 04/06/2009 (Enrolled)
Class Location: Meeting House Class Dates: 06/15/2009 to 06/19/2009
Meeting House 8:30A to 3:30P
1507 E. 116th Street M,Tu,W,Th,F
Carmel, IN 46032 Scheduled Sessions. 5
(317)848 -7275
Fee Details: Fee Descri Amo Co unt Di scount Sale Tax Total Fee
Outdoor Explorers Re 75.00 1.00 0.00 0.00 75.00
Late Pick Up Fee 14.00 1.00 0.00 0.00 14.00
Special Questions: Child's T -Shirt Size YS
Child's Swimming Level Adv
GIL Code Description Ac count Number Cst Cntr Descri tion Acco Number Amoun
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 36.00 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 06/25/09 16:30:36 by NUP FEES ADJUSTED ON CHANGED ITEMS 36.00
DISCOUNT APPLIED AGAINST THESE FEES 0.00
SALES TAX CHARGED ON CHANGED FEES 0.00
NET AMOUNT FROM CHANGED ITEMS 36.00
TOTAL AMOUNT REFUNDED 36.00
NEW NET HOUSEHOLD BALANCE 0.00
Page 1
ACTIVITY REFUND RECEIPT
Receipt 286794
Payment Date: 06/25/2009
Household 17499
Refund of 36.00 Made By REFUND FINAN With Reference
r
All refunds re subject to State Board of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
iss ed. N ash or credit card refunds.
v/-\
ed Si atv Date Authorized Signature Date
UU
AM
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.
Simmons, Cynthia Terms
12519 Windsor Drive Date Due
Carmel, IN 46033
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6125109 286794 Refund 36.00
Total 36.00
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.
Simmons, Cynthia Allowed 20
12519 Windsor Drive
Carmel, IN 46033
In Sum of
36.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept
1046 286794 4358400 36.00 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
2 -Jul 2009
Signature
36.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund