HomeMy WebLinkAbout321586 02/13/18 -0
CITY OF CARMEL, INDIANA VENDOR: 114500
ONE CIVIC SQUARE TIMOTHY J. GREEN CHECK AMOUNT: $"""""400.00•
=4 CARMEL, INDIANA 46032 11468 SENIE LANE CHECK NUMBER: 321586
v, � CARMEL IN 46032 CHECK DATE: 02/13/18
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 02.13 .18 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 114500 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TIMOTHY J. GREEN IN SUM OF$ CITY OF CARMEL
11468 SEN I E LANE 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
$400.00
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
02.13.18 50-239.90 $400.00 1 hereby certify that the attached invoice(s),or 2/13/18 02.13.18 2018 Health Savings Account $400.00
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, February 13,2018
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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
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2018 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Payroll: Please return check to Human Resources for distribution
Plan Participant/Payee:
Timothy Green
11468 Senie Lane
Carmel, IN 46032
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: February 13,2018
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FLEa 13 2018
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