HomeMy WebLinkAbout247145 07/15/15 %'�,A,,F. CITY OF CARMEL, INDIANA VENDOR: 358069
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.� � �:,• ONE CIVIC SQUARE KIMBERLY AND STEVEN BABE CHECK AMOUNT: $"'t*""300.00*
a CARMEL, INDIANA 46032 14138 SHELBORNE ROAD CHECK NUMBER: 247145
9;y;�,_ '�' WESTFIELD IN 46074 CHECK DATE: 07/15/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 300.00 OTHER EXPENSES
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:
Kimberly Babb
14138 Shelborne Road
Westfield,IN 46074
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 6,2015
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
Kimberly Babb
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07106/15 0 7.0-8-1-5 Savings AGGeunt incentive $300.00
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
20Clerk-Treasurer
VOUCHER N4flM4� WARRANT NO.
ALLOWED 20
Kimberly Babb IN SUM OF $
14138 Shelborne Road
Westfield, IN 46074
t
300 00
ON ACCOUNT OF APPROPRIATION FOR
_301 Medical Fund
Board Members
INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.
# I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
07.06.15 301 $300.00 the materials or services itemized thereon
for which charge is made were ordered and
i
received except
i
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund