HomeMy WebLinkAbout320956 01/17/18 CITY OF CARMEL, INDIANA VENDOR: 369140
ONE CIVIC SQUARE JANICE DAVIS CHECK AMOUNT: $"*""588.75`
?� CARMEL, INDIANA 46032 14846 VICTORY COURT CHECK NUMBER: 320956
v._ CARMEL IN 46032 CHECK DATE: 01/17/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT_ DESCRIPTION
301 5023990 01.16.18 588.75 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 369140 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
JANICE DAVIS IN SUM OF$ CITY OF CARMEL
14846 VICTORY COURT 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
$588.75
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
01.16.18 50-239.90 $588.75 I hereby certify that the attached invoice(s),or 1/16/18 01.16.18 Refund retiree insurance payments $588.75
301 301 301 301
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
Tuesday,January 16,2018
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
January 16, 2018
Refund retiree insurance payments for Janice Davis (spouse of James Davis), who was eligible
for Medicare on September 1, 2017, and thus ineligible for the City of Carmel Employee Health
Benefit Plan.
From Medical Fund(301)
PUments
September 2017 $196.25
October 2017 $196.25
November 2017 $196.25
Total Refund Due $588.75 o
JAN 1 6 2018
Pay to: Janice Davis
i
14846 Victory Courta ; i �,P - .�✓ n �
Carmel, IN 46032L