HomeMy WebLinkAbout300880 07/21/16 CITY OF CARMEL, INDIANA VENDOR: 0035 662
® ONE CIVIC SQUARE FRA K VALLONE CHECK AMOUNT: $*******400.00*
s. ?� CARMEL, INDIANA 46032 10707 MORRISTOWN CT CHECK NUMBER: 300880
CARM LIN 46032 CHECK DATE: 07/21/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 071816 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
FRANK VALLONE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
10707 MORRISTOWN CT IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CARMEL, IN 46032 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$400.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
301 Medical Fund Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
071816 50-239.90 $400.00 1 hereby certify that the attached invoice(s),or 7/18/16 071816 Health Savings Account Incentive $400.00
301 301 301 301
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday,July 18,2016
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
City of Carmel EMD1 :yee,Health Benefit Plan
Health Savin s Account:Incentive
g. .
The.retired p1m parficipant listed below has el cted.Plan A:for 2016 and is;eligible for a,bi=.
annual contribution to.his:or her HSA account as authorized by Resolution BPW-10-03=12-02.
Pa oll: Please return.check to Humann Resou l cess for distribution.'
Plan Participant/Payee:
Frank Vallone.
10707 Morristown.Court
CarmeLIN '46032 :.
Amount:. $400.00 : : : : .
Fund: Medical Escrow.Fund;(301)
Date: July:18; 2016