HomeMy WebLinkAbout328800 08/14/18 �`%���p � CITY OF CARMEL, INDIANA VENDOR: 372696
® ONE CIVIC SQUARE TIMOTHY T.TICKLE CHECK AMOUNT: $*******200.00*
s. ' CARMEL, INDIANA 46032 135 BRAEWICK COURT CHECK NUMBER: 328800
°MUTON�.` CARMEL IN 46033-3828 CHECK DATE: 08/14/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 200.00
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372696 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TIMOTHY T. TICKLE IN SUM OF$ CITY OF CARMEL
135 BRAEWICK 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 46033-3828
Payee
$200.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire 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
0 50-239.90 $200.00 1 hereby certify that the attached invoice(s),or 8/13/18 0 $200.00
1120 102 1120 102
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
Monday,August 13,2018
David Haboush
Fire 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
i t P
;s
CITY . i 'C=_ EL
JAMES BRAINARD, MAYOR
August 13, 2018
Timothy T. Tickle
135 Braewick Ct
Carmel, IN 46033-3828
RE: RUN#20154438:1 DOS 08/31/2015 Megan Tickle
Dear Timothy T. Tickle:
Enclosed you will find a refund check for$200.00.
We received your payment check 4477672032 on 12/05/2016 for$200.00
Collection payment received check#570833095 on 07/02/2018 for$548.24
This created an overpayment of$200.00
Refund to be issued to Timothy T. Tickle.
If you have any questions, please feel free to contact me at (317) 571-2604.
Sincerely,
Michelle T. Harrington
EMS Billing Administrator
CARNIEL FIRE DEPARTMENT
STEVEN A. COUTs HEADQUARTERS
(-,.,...-, rNT A(-r)2 ) 29-7 C-'1 ')Knn V... 21'7 x'71 '��9C
CITY OF CARMEL FIRE DEPT
1 2 CIVIC SQUARE
CARMEL, IN 46032-
2584
Cz"T• (317) 571 2604 Federal ID#356000972
Patient Name: TICKLE, MEGAN
MEGAN TICKLE CITY OF CARMEL FIRE DEPT
135 BRAEWICK CT 2 CIVIC SQUARE
CARMEL, IN 46033 CARMEL, IN 46032-2584
TO ASSURE PROPER CREDIT, RETURN Statement Date Patient ID JAMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 08/13/18 990111487
Ticket#: 20154438:1
Date of Service: 8/31/2015
DETACH HERE
REFUND FOR TIMOTHY TICKLE $200.00 OVERPAYMENT. THANK YOU
• 1_.
MAKE CHECKS PAYABLE TO: CITY OF CARMEL FIRE DEPT BALANCE
Pay online at www.govpaynet.com with PLC#7487 Run Number 20154438:1
Online Payment will charge a service fee.
`Date of Service, `°Descri tion, C atierit Name � �s
Date i_ Payments) 5
Charges
8/31/2015 *ADVANCED LIFE TICKLE, MEGAN $475.00
8/31/2015 *MILEAGE TICKLE, MEGAN $73.24
---------------------------------
Charge Total: $548.24
Payments
Paid By. Invoice 08/31/15 $548,24
Paid By: TICKLE, MEGAN Bad Debt 11/17/16 ($548.24)
Paid By: TICKLE, MEGAN Payment �'j'76gZ 03212/09/16
($200.00)
Paid By: TICKLE, MEGAN Bad Debt Invoice Reversal 12/09/16 $200.00
Paid By: TICKLE, MEGAN Bad Debt Invoice Reversal 07/24/18 $348.24
Paid By: TICKLE, MEGAN COLLECTION PAYMENT 07/24/18 ($548.24)
ckef'1; S'7083309 5
BALANCE $0.00
CARMZI CITY OF CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL, IN 46032-2584
CZ"= '• (317) 571 2604 Federal ID#356000972
Patient Name: TICKLE, MEGAN
MEGAN TICKLE CITY OF CARMEL FIRE DEPT
135 BRAEWICK CT 2 CIVIC SQUARE
CARMEL, IN 46033 CARMEL, IN 46032-2584
TO ASSURE PROPER CREDIT, RETURN Statement Date Patient ID AMOUNT PAID
THIS PORTION WITH YOUR PAYMENT 08/13/18 990111487
Ticket#: 20154438:1
Date of Service: 8/31/2015
DETACH HERE
REFUND FOR TIMOTHY TICKLE$200.00 OVERPAYMENT. THANK YOU
Paid By: TICKLE, MEGAN REFUND 08/13/18 $200.00
BALANCE $0.00