HomeMy WebLinkAbout239190 11/19/14 CITY OF CARMEL, INDIANA VENDOR: 00351238
ONE CIVIC SQUARE DONALD W ALLEN CHECK AMOUNT: $*******1 19.00*
s. ?� CARMEL, INDIANA 46032 13440 ABERCORN ST CHECK NUMBER: 239190
CARMEL IN 46032 CHECK DATE: 11/19/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 11.06.14 119.00 OTHER EXPENSES
301
MEDICAL ESCROW FUND
REFUND TO: Donald Allen
13440 Abercorn Street
Carmel, IN 46032
AMOUNT: $119.00
REASON: Wife and daughter's dental coverage should have been cancelled when
Don went on Medicare in September. Refund September and October
payments of$59.50 each.
AUTHORIZED
BY: Barbara Lamb, Director of Human Resources
DATE: November 6, 2014
f
Submitted To
NOV 17 2014
Clerk Treasurer
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.
Donald Allen Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/06/14 i
$119.00
Total 19.00
hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER Mim-4 WARRANT NO.
ALLOWED 20
D1nald ,4llen
IN SUM OF $
13440 Abercorn Street
Carmel, In 46032
X119.00
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
or blll(s) is (are) true and correct and that
11.06.14 301 $ 19.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
I
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}
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund