HomeMy WebLinkAbout247615 07/15/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 00351483
ONE CIVIC SQUARE JOHN CRISLER CHECKAMOUNT: $*******300.00*
CARMEL, INDIANA 46032 139 74TH ST CHECK NUMBER: 247615
SOUTH HAVEN MI 49090 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 50'23990 300.00 OTHER EXPENSES'
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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-10-03-127 02.
Please return check to Human Resources for further processing.
Plan Participant/Payee:
John Crislerl
139 741h Street
South Haven,MI 49090
Amount: $30.00
Fund: Medical Escrow Fund (301)
Date: July 6, 3015
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Submitted To
JUL 13 2015
Clerk Treasurer
Prescribed by State Board of AccountE City Forrn No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
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
John Crisler
Purchase Order No.
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Terms
Date Due
Invoice Invoice Description Amount
Date Number, (or note attached invoice(s) or bill(s))
07/06116 970616 HA h Savings Accalint Incenthig $300 00
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Total $300.00
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 5-11-1011.6.
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Clerk-Treasurer
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VOUCHER N007/13/15 WARRANT NO.
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ALLOWED 20
.John Crisler IN SUM OF $
139 74th Street
South Haven, MI 49090
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$$300.00
ON ACCOUNT OF APPROPRIATION FOR
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301 Medical Fund
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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
07.06.15 301 $300.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
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t
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund