167698 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 362350 Page 1 of 1
ONE CIVIC SQUARE GHAZAL SOHRABI
CARMEL, INDIANA 46032 10862OUEENSBURY CHECK AMOUNT: $80.00
CARMEL IN 46033 CHECK NUMBER: 167698
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CHECK DATE: 1/7/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM OUNT DESCRIPTION
1047 4358400 207923 80.00 REFUNDS AWARDS INDE
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I
PASS REFUND RECEIPT
Receipt 207923
Payment Date: 12/10/2008
Household 9805
Home Phone: (317)578 -0022 6 DC 9 2
Work Phone:
GHAZAL SOHRABI Monon Center
10862 QUEENSBURY Carmel IN 46032
CARMEL IN 46033
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Pass Details
CANCELLATION Refund Of 60.00
Pass Holder: Ghazal Sohrabi Fees Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Yly FT Alt Res (YFTAR), #11963 0.00 0.00 0.00 0.00 0.00
Valid Dates: 07/15/2008 to 07/15/2009 Pass Cancellation)
Cancel Reason: Changed pass, got charged for both
G/L Code Descri Account Number Cst Cntr Description Account Number Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Acct here 80.00 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 CREDIT HOUSEHOLD BALANCE 20.00
Processed on 12/10108 18:19:37 by EMS FEES CHANGED ON CANCELLED ITEMS 60.00-
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
•NET AMOUNT`FROM'CANCELLED ITEMS 0100.
HH BALANCE APPLIED TO THIS RECEIPT 20.00
70TAL AMOUNTt:REFUNDED 'C w 80100!.'
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 80.00 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 credit card refunds.
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Authori ed Signature Date Authorized Signature Date
Page 1
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.
Sohrabi, Ghazal Terms
10862 Queensbury Date Due
Carmel, IN 46033
Invoice invoice Description
Date Number {or note attached invoice {s) or bill(s)) Amount 80.00
12110/08 207923 Refund
7o #al 80.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with 1C 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Sohrabi, Ghazal Allowed 20
10862 Queensbury
Carmel, IN 46033
In Sum of
80.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 207923 4358400 80.00 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
i
Signature
80.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund