319684 12/15/17 t Cqy
,y CITY OF CARMEL, INDIANA VENDOR: 00351007
ONE CIVIC SQUARE ALAN YOUNG CHECK AMOUNT: $*******264.77*
CARMEL, INDIANA 46032 8772 PINE ACRES CHECK NUMBER: 319684
? KALAMAZOO MI 49009 CHECK DATE: 12/15/17
DEPARTMENT_ ACCOUNT PO NUMBER _ INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 12 .13 .17 264.77 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed byState Board of Accounts City Form No.201(Rev.1995)
Vendor# 00351007 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ALAN YOUNG IN SUM OF$ CITY OF CARMEL
8772 PINE ACRES 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.
KALAMAZOO, MI 49009
Payee
$264.77
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
301 Medical Fund Terms
301 Medical Fund Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
12.13.17 50-239.90 $264.77 1 hereby certify that the attached invoice(s),or 12/13/17 12.13.17 Reimburse December Medical Prem $264.77
301 301 301 301 (Premium Holiday)
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
Thursday, December 14,2017
Lamb, Barbara
Director
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
INVOICE
The Board of Public Works and Safety has approved a premium holiday for December 2017.
Please process refunds from the Medical Escrow Fund(301) for the following retirees,whose
monthly contributions will be automatically deducted from their PERF pension checks.
These retirees should already be in the claims system except for Viehe, Whitaker and Young.
Brad Bartrom $235.50
Mark Callahan $196.25
Barry Crane $1,765.00
Leland Goodman $235.50
.Timothy Green $886.00
Stephen Reeves $886.00
Frank Vallone $886.00
Robert VanVoorst $196.25
.Richard Viehe $429.11
2374 W State Rd 234 !
Fortville, IN 46040
Charles Whitaker $246.51 DEC 13 2017
308 W Haydn Dr
Apt 1318 `iv na,�av'gym re
d .y
Carmel, IN 46032C
fPine* Acres
$264.77 Dr 49009