HomeMy WebLinkAbout236566 08/27/14 0n'.��A,, CITY OF CARMEL, INDIANA VENDOR: 368604
ONE CIVIC SQUARE MARSHA WEINKAUF CHECK AMOUNT: $*******161.09*
i _�
CARMEL, INDIANA 46032 207 CREEKWOOD DR CHECK NUMBER: 236566
+�'�rurl WESTFIELD IN 46074 CHECK DATE: 08/27/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 161.09 REFUND
2
A
Ci EL
JAMES BRAiNARD, MAYOR
August 25, 2014
Marsha Weinkauf
207 Creekwood Drive
Westfield, IN 46074
RE: Ticket 9 20143293:1 D.O.S. 07/04/2014
Dear Marsha Weinkauf:
Enclosed you will find a refund check in the amount of$ 161.09.
On July 17, 2014 we received your payment for$490.10 account paid in full.
AARP Medicare Complete processed your claim and paid $ 161.09 on August 15, 2014.
Duplicate payments received and the amount due to you is $ 161.09.
If you have any questions, please feel free to contact me at(317) 571-2604.
Sincerely,
&WLWJ-
Michelle T. Harrington
Billing Administrator
CARMEL FIRE DEPARTbIENT
STEVEN A. CouTS HEADQUARTERS
Two Civic SQUARE, CARMEL, IN 46032 OFFICE 317571.2600, FAx 317.771.2615
CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
" k CARMEL, IN 46032-7543
(317) 571 2604 Federal ID#356000972
Patient Name: WEINKAUF, MARSHA
MARSHA WEINKAUF CARMEL FIRE DEPARTMENT
207 CREEKWOOD DR 2 CIVIC SQUARE
WESTFIELD , IN 46074 CARMEL, IN 46032-7543
TO ASSURE PROPER CREDIT, RETURN Statement Date I Patient ID JAMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 08/25/14 990107459
Ticket# : 20143293:1
Date of Service: 7/4/2014
DETACH HERE
WE RECEIVED YOUR PAYMENT CK 9959 FOR$490.10 AND AARP PROCESSED CLAIM
I,
CK 41256256 PAID $161.09. REFUND DUE TO YOU IS $ 161.09.THANK YOU
MAKE CHECKS PAYABLE TO: CARMEL FIRE DEPARTMENT I BALANCE ;$0:00
Pay online at www.govpaynet.com with PLC#7487 Run Number 20143293:1
Online Payment will charge a service fee.
Date of`Service :-` Description . P,atient'Name.. ' ° Charge(s): Date Payment(s)
Charges
7/4/2014 *ADVANCED LIFE WEINKAUF, MARSHA $475.00
7/4/2014 *MILEAGE WEINKAUF, MARSHA $15.10
---------------------------------
Charge Total: $490.10
Payments
Paid By: Invoice 07/04/14 $490.10
Paid By: WEINKAUF, MARSHA Payment 07/17/14 ($490.10)
Paid By: AARP/MEDICARE COMPLETE MEDICARE PAYMENT 08/15/14 ($161.09)
Paid By: WEINKAUF, MARSHA REFUND 08/25/14 $161.09
BALANCE $0.00
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
-
CITY OF CARMEL
An invoice or 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
ALLOWED 20
IN SUM OF $
i
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund