HomeMy WebLinkAbout320240 01/04/18 f,
CITY OF CARMEL, INDIANA VENDOR: 068150
ONE CIVIC SQUARE BARRY CRANE CHECK AMOUNT: $*****1,027.00*
CARMEL, INDIANA 46032 11208 HAVERSTICK RD CHECK NUMBER: 320240
CARMEL IN 46033 CHECK DATE: 01/04/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 01. 03 .18 1,027.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 068150 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
BARRY CRANE IN SUM OF$ CITY OF CARMEL
11208 HAVERSTICK RD 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 46033
Payee
$1,027.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
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
01.03.18 50-239.90 $1,027.00 1 hereby certify that the attached invoice(s),or 1/3/18 01.03.18 $1,027.00
301 301 301 301
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
F which charge is made were ordered and
I
received except
Wednesday,January 03,2018
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
Date: January 3, 2108
Amount: $1,027.00
Pay To: Barry Crane
1923 Yandes Street
Indianapolis, IN 46202 (note change of address)
From: Medical Fund (301)
Explanation: Mr. Crane, a retiree, is paying his insurance premiums through a deduction from
his PERF-issued pension. Mr. Crane recently divorced and his premium change was to take
effect January 1, 2018. Because his change form was sent in without a required signature, it had
to de re-submitted and the effective date was delayed one month (until February 2018).
Mr. Crane's current monthly premium is $738.00, but he will have $1,765.00 deducted from his
January pension check. This payment will refund the difference.