HomeMy WebLinkAbout327153 07/10/18 a o!.4Qgy
CITY OF CARMEL, INDIANA VENDOR: 372554
ONE CIVIC SQUARE CIOX HEALTH CHECKAMOUNT: $********23.13*
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CARMEL, INDIANA 46032 P.O.Box 409822 CHECK NUMBER: 327153
9A��TON/gyp'.` ATLANTA GA 30384-9822 CHECK DATE: 07/10/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 0245504445 23.13 SPECIAL INVESTIGATIQN
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372554 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
CIOX HEALTH IN SUM OF$ CITY OF CARMEL
P.O. BOX 409822 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.
ATLANTA, GA 30384-9822
Payee
$23.13
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police 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
0245504445 43-582.00 $23.13 1 hereby certify that the attached invoice(s),or 5/17/18 0245504445 document retrieval $23.13
1110 101 1110 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,June 28,2018
Jim Barlow
Chief
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Ciox Health CiO' X Invoice #: 0245504445
P.O.-Box 409822.
HEALTH Date: 5/17/2018
Atlanta, GA 30384-9822 INVOICE Customer #: 2147. 327
Fed Tax ID 58 - 2659941
1-800-367-1500
Ship o; Bill to: Records from:
PROSEUTING ATTY HAMILTON CO PROSEUTING ATTY HAMILTON CO ESKENAZI HEALTH
PROSECUTING ATTY HAMILTON CO PROSECUTING ATTY HAMILTON CO .720 ESKENAZI AVENUE
3 CIVIC SQ 3 CIVIC SQ INDIANAPOLIS, IN 46202
.CARMEL, IN 46032-2584 CARMEL, IN 46032-2584
Requested By: PROSECUTING ATTY HAMILTON CO DOB: 042161
Patient Name: DEAN GOSSETT
Description Quantity Unit Price Amount
Basic Fee 20.00
Retrieval Fee 0.00
Per Page Copy (Paper) 1 3 0.50. 1.50
Per Page Copy (Paper) 2 10 .0.00 0.00
Shipping- 1.63
Subtotal 23.13
Sales Tax 0.00
Invoice.Total 23.13
Balance Due 23.13 .
Pay your invoice online at https:Hpaycioxhealth.coM/p8 /
Terms: Net 30 days Please remit this amount : $ 23.13 (USD)