249940 09/23/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 366719
ONE CIVIC SQUARE WELLNESS COUNCIL OF INDIANA CHECK AMOUNT: $*****1,000.00*
CARMEL, INDIANA 46032 115 W WASHINGTON ST,STE 850 S CHECK NUMBER: 249940
INDIANAPOLIS IN 46204 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 500663065 1,000.00 OTHER EXPENSES
z Wellness Council of Indiana
115 W Washington St, Ste 850 S, Indianapolis, IN, 46204, USA
Phone: (317)264-2168 Fax: (317)264-6855
P�P ��� w����.wellnessindiana.org
wELLNEss OiN rO\P
�N COOPERAZxON
Wellness Council of Indiana Membership Proposal
Date:16-Sep-2015 Order Number: 5000663065
Order Date 16-Sep-2015
Bill-To:000000090785 Invoice Number:
Cite of Carmel
One Civic Sq
Carmel,IN 46032-2584
Product Fulfill Status Status Qty Unit Price Adjustment Total
Wellness Council Member Dues A P 1 $1;000.00 $0.00 $1,000.00
11/1/15 to 10/31/16
Shipping: $0
Sales Tax: $0
Total $1,000.00
Paid To Date:
Current Amount Due: $1,000.00
a - -
Submitted To
SEP 2 1 HIS
Clerk Treasurer
Please detach the lower portion and return it with your payment.Thank you.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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
Wellness Council of Indiana
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
- —I
Total $1,000.00
I 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 NOV21115 WARRANT NO.
ALLOWED 20
Wellness Council of Indiana
IN SUM OF $
115 W Washington St, Ste 850 S
Indianapolis, IN 46204
,000.00
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
5000663065 301 $ ,000.00 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