HomeMy WebLinkAbout304349 10/26/16 CITY OF CARMEL, INDIANA VENDOR: 371266 CHECK AMOUNT: S*******129.64*
31 ONE CIVIC SQUARE RICKINDER BAINS
r � CARMEL, INDIANA 46032 13344 KICKAP00 TRAIL CHECK NUMBER: 304349
9M o CARMEL IN 46033 CHECK DATE: 10/26/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 20160678 129.64 OTHER EXPENSES
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
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 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
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CITY MEL
JAMES BRAINARD, MAYOR
October 24, 2016
Rickinder Bains
13344 Kickapoo Trail
Carmel, IN 46033
RE: Ticket#20160678:1 D.O.S. 02/08/2016 Duplicate Payments Received
Dear Rickinder Bains:
Enclosed you will find a refund,check in the amount of$129.64.
We received your payment on May 2, 2016 for$129.64.
On October 13, 2016 your Money for Health account sent a check also for$129.64.
Overpayment invoice—refund issued to patient for$129.64
If you have any questions, please feel free to contact me at(317) 571-2604.
Sincerely,
"�'f "C
Michelle T. Harrington
Billing Administrator
CARNIEL FIRE DEPARTIIIENT
STEVEN A. CouTS HEADQUARTERS
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CARMEL FIRE DEPARTMENT
;yam 2 CIVIC SQUARE
" CARMEL, IN 46032-2584
• (317) 5712604 Federal ID#356000972
Patient Name: BAINS, RICKINDER S
RICKINDER BAINS CARMEL FIRE DEPARTMENT
13344 KICKAPOO TRAIL 2 CIVIC SQUARE
CARMEL, IN 46033 CARMEL, IN 46032-2584
TO ASSURE PROPER CREDIT, RETURN Statement Date Patient ID AMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 10/24/16 990113038
Ticket# : 20160678:1
Date of Service: 2/8/2016
DETACH HERE
DUPLICATE PAYMENTS RECEIVED. MAY 2, 2016 THE PATIENT PAID $129.64. MONEY FOR
HEALTH ACCOUNT SENT A CHECK FOR$129.64 ON OCTOBER 13, 2016. REFUND ISSUED TO
PATIENT.THANK YOU
MAKE CHECKS PAYABLE TO: CARMEL FIRE DEPARTMENT BALANCE Oct003
Pay online at www.govpaynet.com with PLC#7487 Run Number 20160678:1
Online Payment will charge a service fee.
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Charges
2/8/2016 *ADVANCED LIFE BAINS, RICKINDER S $575.00
2/8/2016 *MILEAGE BAINS, RICKINDER S $73.20
---------------------------------
Charge Total: $648.20
Payments
Paid By: Invoice 02/08/16 $648.20
Paid By: AETNA US COMMERCIAL INSURANCE 03/14/16 ($518.56)
Paid By: BAINS, RICKINDER S Credit Card Payment 04/30/16 ($129.64)
Paid By. BAINS, RICKINDER S COMMERCIAL INSURANCE 10/13/16 ($129.64)
Paid By: BAINS, RICKINDER S REFUND 10/24/16 $129.64
BALANCE $0.00
CARMEL FIRE DEPARTMENT
'� 2 CIVIC SQUARE
CARMEL, IN 46032-2584
(317) 571 2604 Federal ID#356000972
Patient Name: BAINS, RICKINDER S
RICKINDER BAINS CARMEL FIRE DEPARTMENT
13344 KICKAPOO TRAIL 2 CIVIC SQUARE
CARMEL, IN 46033 CARMEL, IN 46032-2584
TO ASSURE PROPER CREDIT, RETURN Statement Date I Patient ID JAMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 10/24/16 990113038
Ticket#: 20160678:1
Date of Service: 2/8/2016
DETACH HERE
DUPLICATE PAYMENTS RECEIVED. MAY 2, 2016 THE PATIENT PAID$129.64. MONEY FOR
HEALTH ACCOUNT SENT A CHECK FOR$129.64 ON OCTOBER 13, 2016. REFUND ISSUED TO
PATIENT.THANK YOU
MAKE CHECKS PAYABLE TO: CARMEL FIRE DEPARTMENT
Pay online at www.govpaynet.com with PLC#7487 Run Number 20160678:1
Online Payment will charge a service fee.
Date of Service Description" -, Patient Name y ,i rs Charges) Dated Payments) v
Charges
2/8/2016 *ADVANCED LIFE BAINS, RICKINDER S $575.00
2/8/2016 *MILEAGE BAINS, RICKINDER S 1 $73.20
---------------------------------
Charge Total: $648.20
Payments
Paid By. Invoice 02/08/16 $648.20
Paid By. AETNA US COMMERCIAL INSURANCE 03/14/16 ($518.56)
Paid By. BAINS, RICKINDER S Credit Card Payment 04/30/16 ($129.64)
Paid By. BAINS, RICKINDER S COMMERCIAL INSURANCE 10/13/16 ($129.64)
Paid By. BAINS, RICKINDER S REFUND 10/24/16 $129.64
BALANCE $0.00