247283 07/15/15 CITY OF CARMEL, INDIANA VENDOR: 369550
® ONE CIVIC SQUARE BRUCE GRAHAM CHECK AMOUNT: $ ...."300.00"
r CARMEL, INDIANA 46032 11810 N.GRAY ROAD CHECK NUMBER: 247283
CARMEL IN 46033 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 070615 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:
Bruce Graham
11810 North Gray Road
Carmel, IN 46033
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: July 6, 2015
Submitted To
JUL 13 2015
Clerk Treasurer
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
Bruce Graham
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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 N(a7113/15 WARRANT NO.
ALLOWED 20
BF E;e Graham IN SUM OF $
11810 North Gray Road
Carmel, IN 46033
$$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
07.06.15 301 $300.00 the materials or services itemized thereon
for which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund