320095 12/21/17 1y u._CggMf
<<?� w• CITY OF CARMEL, INDIANA VENDOR: 369280
d ONE CIVIC SQUARE TRINITY FREE CLINIC INC CHECK AMOUNT: $*****5,000.00`
CARMEL, INDIANA 46032 1045 W 146TH ST SUITE B CHECK NUMBER: 320095
9y4nN.�o;? CARMELJN 46032 CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1203 4359000 12132017 5,000.00 SPECIAL PROJECTS
VOUCHER NO. WARRANT NO. rwsumeu oy aiaie coara OT Hccounis Gity Form No.201(Rev.1995)
Vendor# 369280 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TRINITY FREE CLINIC INC IN SUM OF$ CITY OF CARMEL
1045 W 146TH ST SUITE B 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.
CARMEL, IN 46032
Payee
$5,000.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Community Relations 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
12132017 43-590.00 $5,000.00 1 hereby certify that the attached invoice(s) or 12/13/17 12132017 $5,000.00
1203 101 1203 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
Thursday, December 14,2017
Heck, Nancy
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
Trinity Free Clinic, Inc. INVOICE
1045 W. 146th St, Suite B #12132017
Trinirg Carmel, IN 46032
e finic (317) 819-0772
www.TririityFreeClinic.org
To: Attn:Sharon Kibbe. 12/13/2017
Office of Mayor Brainard
Carmel City Hall
One Civic Square
Carmel;,IN 46032
QTY .Description Unit Price Line Total..
1 End of Year.Donation $5,000.00 $5;000.00
Subtotal $5,000.00
Sales Tax Total
Total $5,000.00
Thank you for your support!
Trinity Free Clinic
1045 W 146th Street
Carmel, IN 46032