172565 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 362855 Page 1 of 1
ONE CIVIC SQUARE NIGEL SURRIDGE CHECK AMOUNT: $135.00
CARMEL, INDIANA 46032 857 NEVELLE LANE
CARMEL IN 46032
CHECK NUMBER: 172565
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4358400 254798 135.00 REFUNDS AWARDS INDE
ACTIVITY REFUND RECEIPT
ecelpt 254798
ayment Date: 05/01/2009 2 g s °t� 4 r
ousphold 20845
ome Phone: (317)582 -1514
/ork Phone: MAY u 5
BY:.....
NIGEL SURRIDGE Monon Center
857 NEVELLE LANE Carmel IN 46032
CARMEL IN 46032
Phone: (317)848 -7275
Fed Tax ID #35- 6000972
Arollment Details
CANCELLATION Refund Of 31.00
Enrollee Name: Rachel Surridge Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193009 -20 Stingray L4 (Youth) 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/20/2009 (Cancelled)
Class Location: Outdoor lap 4 Class Dates: 07/13/2009 to 07/23/2009
Monon Center 9:OOA to 9:30A
M,Tu,W,Th
Carmel IN 46032 Scheduled Sessions: 8
(317)848 -7275
Fee Details: Fee Descri Amount Count Discount Sales Tax Total Fee
Whale Level 4 (Youth 7.00 1.00 0.00 0.00 7.00
Cancel Reason: Family plan change unable to keep lessons
CANCELLATION Refund Of 52.00
Enrollee Name: Alec Surridge Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193009 -20 Stingray L4 (Youth) 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/20/2009 (Cancelled)
Class Location: Outdoor lap 4 Class Dates: 07/13/2009 to 07/2312009
Monon Center 9:OOA to 9:30A
M,Tu,W,Th
Carmel IN 46032 Scheduled Sessions: 8
(317)848 -7275
Fee Details: Fee Descri Am ount Count Discount Sales Tax Total Fee
Whale Level 4 (Youth 7.00 1.00 0.00 0.00 7.00
cancel Reason: Family plan change unable to keep lessons
CANCELLATION Refund Of 52.00
Enrollee Name: Michael Surridge Fees Tax Discount Prev Paid Cur Paid Amount Due
Activity Number: 193007 -23 Starfish Level 2 7.00 0.00 0.00 7.00 0.00
Enrollment Date: 04/20/2009 (Cancelled)
Page 1
ACTIVITY REFUND RECEIPT
Receipt 254798
Payment Date: 05/01/2009
Household 20845
i;-
Class Location: Outdoor Lap Pool 2 Class Dates: 07/13/2009 to 07/23/2009
Monon Center 9:OOA to 9:30A
M,Tu,W,Th
Carmel, IN 46032 Scheduled Sessions: 8
(317)848 -7275
Fee Details: Fee Description Amount Count Discount Sales Tax Total Fee
Turtle Level 2 (Yout 7.00 1.00 0.00 0.00 7.00
Cancel Reason: Family plan change unable to keep lessons
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 135.00 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 05/01/09 13:19:58 by ALC FEES CHANGED ON CANCELLED ITEMS 156.00
DISCOUNT APPLIED AGAINST CANCELLED FEES 0.00
SALES TAX CHARGED ON CANCELLED FEES 0.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 21.00
NET AMOUNT FROM CANCELLED 135.00
TOTAL AMOUNT REFUNDED 135.00.
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 135.00 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
I s ued. No c h or credit card refunds.
1 1l_ 17
Autho ze ignature 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
1� whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Surridge, Nigel Terms
857 Nevelle Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/1/09 254798 Refund 135.00
Total 135.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
,20_
Clerk- Treasurer
Voucher No. Warrant No.
Surridge, Nigel Allowed 20
857 Nevelle Lane
Carmel, IN 46032
f4 In Sum of
135.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 254798 4358400 135.00 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
7 -May 2009
Signature
135.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund