HomeMy WebLinkAbout304613 10/31/16 1y of 44gy�
CITY OF CARMEL, INDIANA VENDOR: 365200
`/ CHECK AMOUNT: $********37.12*
.� ® �•, ONE CIVIC SQUARE HEALTH PORT
s`.. CARMEL, INDIANA 46032 PO BOX 409822 CHECK NUMBER: 304613
9M�ioN��°'; ATLANTA GA 30384-9822 CHECK DATE: 10/31/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 0202685798 37.12 SPECIAL INVESTIGATION
t
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
HEALTH PORT ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 409822 IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
ATLANTA, GA 30384-9822 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$37.12 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police 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
0202685798 43-582.00 $37.12 1 hereby certify that the attached invoice(s),or 10/13/16 0202685798 case#16-58484 $37.12
1110 101 1110 101
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, October 24,2016
Tim Green
Chief of Police
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
HealthPort i Invoice #: 0202685798
P.O. Box 409822 �� HealthPort.. Date: 10/13/2016
Atlanta, GA 30384-9822 INVOICE Customer #: 1979868
Fed Tax ID 58- 2659941
(770) 754- 6000
Ship to: Bill to: Records from:
SGT NANCY Z SGT NANCY Z IU HEALTH NORTH HOSPITAL
CARMEL POLICE DEPT CARMEL POLICE DEPT 11700 NORTH MERIDIAN STREET
3 CIVIC SQ 3 CIVIC SQ CARMEL, IN 46032
CARMEL, IN 46032-2584 CARMEL, IN 46032-2584
Requested By: CARMEL POLICE DEPT 73743828
Patient Name: FELTRINELLI MICHELLE
Description Quantity Unit Price Amount
Basic Fee 20.00
Retrieval Fee 0.00
Per Page Copy (Paper) 1 29 0.50 14.50
Per Page Copy (Paper) 2 10 0.00 0.00
Shipping 2.62
Subtotal 37.12
Sales Tax 0.00
Invoice Total 37.12
Balance Due 37.12
Pay your invoice online at www.HealthPortPay.corn
Terms: Net 30 days Please remit this amount : $ 37.12 (USD)
.......................................................... .1�c................................................................................................................................