HomeMy WebLinkAbout300876 07/21/16 a`/ • CITY OF CARMEL, INDIANA VENDOR: 370$46
® ONE CIVIC SQUARE JA ES TONEY CHECK AMOUNT: $*******400.00*
CARMEL, INDIANA 46032 6950 46TH AVENUE NORTH#5 CHECK NUMBER: 300876
9o;��To*��' ST.P TERSBURG FL 33709 CHECK DATE: 07/21/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 071816 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO.
ALLOWED 20 .
�gSro LO- AvnjuC K,1627-H A6'
IN SUM OF$
S'T Pei-eys UZ(- , FL 33709
$ 400, 00
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#-o� Volef Ne.-AGGT#/-FITL� AMOUNT
DEPT.# --Vhereby--certify-thatthe attached invoice(s),
h?, vD or 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
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund
City of Cannel'Errip ogee Health Berief t;Plan
Health Saving Account Inc:entv.e.
The.ietired p Ah barticipani listedbelow lids: ;ected.Plan A:foi 2016 and is-eligible for abi=.
annual contribution to,his:or her HSA aeeoun ; as authoiized by Resolution BPW710-03=12-02.
Payroll:. Please return.check to Human Reno rtes for distribution.
Plan Participant/Payee:
James:Tone
Y
6950 46th Avenue North 45 USE THIS ST ET ADDRESS
St..Petersbiirg :FL 33709
Amount;. $400.00 : : . . .
Fund:: .Medical Escrow Fund:(301).:
Date: July:18;2016