HomeMy WebLinkAbout242512 02/24/15 CITY OF CARMEL, INDIANA VENDOR: 369140
ONE CIVIC SQUARE JANICE DAVIS CHECK AMOUNT: $"""**""300.00*
CARMEL, INDIANA 46032 14846 VICTORY COURt' CHECK NUMBER: 242512
9M1i�IUN�p?,; CARMEL IN 46032 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 eligible for 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:
Janice Davis
14846 Victory Court
Carmel, IN 46032
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: February 23, 2015
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.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
Janice Davis
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ings Account Contribution $300 On
02123115 0275-15 ealth Savi
Total $300.00
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 4/15 WARRANT NO.
ALLOWED 20
janice Davits IN SUM OF $
14846 Victory C:nl,rt
(`nrmpl In 46032
$300,00
ON ACCOUNT OF APPROPRIATION FOR
301 Mo!;r2-1 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
i09 93 35 201 $300.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
20
SignatureC
i; Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund