HomeMy WebLinkAbout242551 02/24/15 fr�4A
CITY OF CARMEL, INDIANA VENDOR: 358069
ONE CIVIC SQUARE KIMBERLY BABB CHECK AMOUNT: $"** -300.00*
CARMEL, INDIANA 46032 14136 SHELSORNE ROAD CHECK NUMBER: 242551
WESTFIELD IN 46074 CHECK DATE: 02/24/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 300.00 HSA
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2015 and is eligiblefor a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02:
Please return check to Human Resources for further processing.
Plan Participant/Payee:
Kimberly Babb
14138 Shelborne Road
Westfield, IN 46074
Amount: $300.00
Fund. Medical Escrow Fund (301)
Date: February 23, 2015
� I
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.
Kimberly Babb Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/23/15 02.23
.15 Ann-al Health Savings Account Contribution $300.00
Total
1 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 NCb?/24/15 WARRANT NO.
ALLOWED 20
Komherly Babb IN SUM OF $
14138 Shelborne Road
Westfield, IN 46074
$$300.00
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 bill(s) is (are) true and correct and that
02.23.15 300.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
20
Signature � ^
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund