179767 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 363600 Page 1 of 1
ONE CIVIC SQUARE TERRY MILLER CHECK AMOUNT: $64.00
CARMEL, INDIANA 46032 10640 BROADWAY ST
INDIANAPOLIS IN 46280 CHECK NUMBER: 179767
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT P O NUMBER I NVOICE NUMBER A DESCRIPTION
1047 4358400 356207 64.00 REFUNDS AWARDS INDE
PASS REFUND RECEIPT
Receipt 356207
Payment Date: 11/18/09
Household 29716
Moron Center Terry Miller Fpm Ph: (317)581 -0247
Carmel IN 46032 10640 Broadway St. Wk Ph: (317)338 -7497
Indianapolis IN 46280 Call Ph: (317)224-3471
terry7600 @sbcglobal.net
Phone: (317)848 -7275
Fed Tax ID #35-6000972
Pass Details
CANCELLATION Refund Of 64.00
Pass Molder: Wesley Mccoy Fees +Tax Discount Prev Paid Cur Paid Amount Due
Pass Type: Prm Yr Adult (PRMYRADR), #80886 32.00 0.00 0,00 32.00 0.00
Valid Dates: 09/05/2009 to 0910512010 Pass Cancellation)
Cancel Reason: Wesley's pass needed a voided check to be continued through oct/nov. Wesley's pass was
never suppose to have came out of Terry Miller's checking account only 1st mo. payment
q1L Code Descri lion,. Account Number Cst Cntr Descriptio nccou ni,_N umb er_.__ ,____Amount
999999 Control Account (AP) Enter Control Acct CNTRL Control Account (AP) Enter Control Ac ct here 64.00 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 alter the checks have been written to the customers.
PREVIOUS NET HOUSEHOLD BALANCE 0.00
Processed on 11/18109 19:03:08 by TLP PEES CHANGED ON CANCELLED ITEMS 96.00
SURCHARGE APPLIED AGAINST CANCELLED FEES 32.00
l AMOUNT:FROM,CANCELLED ITEMS' 64:00 =:r
TOTAL AMOUNT;REF.UNDED 64':00';
NEW NET HOUSEHOLD BALANCE 0.00
Refund of 64.00 Made qY RE(U; FI I AN With Reference =7 rrd voided ck; pass cncl'd afterlmo
All refur�ds -are subject tQ� tax(rt3efard of Accounts claim procedure and may take 4 -6 weeks to process. A check will be
1 i. No cash or credit cafd r funds.
Ln c,
J Authorized Sj na ure Date Authorized Signature Date
I
1
:C N O V 2009
X37:
Page 0 1
ACCOUNTS PAYABLE VOUCHER
i 4 e CITY OF CARMEL
y 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.
Miller, Terry Terms
10640 Broadway St. Date Due
Indianapolis, IN 46280
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/18/09 356207 Refund 64.00
Total 64.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Miller, Terry Allowed 20
10640 Broadway St.
Indianapolis, IN 46280
In Sum of
64.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
4047 356207 4358400 64.00 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
19 -Nov 2009
Signature
64.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund