329420 08/27/18 CITY OF CARMEL, INDIANA VENDOR: 372713
ONE CIVIC SQUARE JAMES WILLIAMSON CHECK AMOUNT: $*******106.91
r•. ,?� CARMEL, INDIANA 46032 2421 EMERALD PINES LANE CHECK NUMBER: 329420
9yTON�. WESTFIELD IN 46074 CHECK DATE: 08/27/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4110000 082218 106.91 FULL TIME REGULAR
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 372713 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
JAMES WILLIAMSON IN SUM OF$ CITY OF CARMEL
2421 EMERALD PINES 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.
WESTFIELD, IN 46074
Payee
$106.91
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Human Resources 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
08.22.18 41-100.00 $106.91 1 hereby certify that the attached invoice(s),or 8/22/18 08.22.18 Withholdings Refund/Reimbursement $106.91
1201 101 1201 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,August 23,2018
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
Lamb, Barbara A
From: Wolfgang, Sue E
Sent: Wednesday,August 22, 2018 12:02 PM
To: Bingman,Ann; Powers, Marcia
Cr Lamb, Barbara A
Subject: Contact information for tax refund claims
The three deceased employees owed tax refunds are as follows:
Jeffrey Peters
Entire check($462.93)should go to Mary Jane Peters
■ SSN: 309-70-6464
■ DOB: 10/17/1962
• Address: 990 Tillson Drive,Zionsville, IN 46077
Mark Robinson
Check($819.36)should be split evenly into thirds($273.12 each)and go to Jamie Robinson,Jordan
Robinson and Brock Robinson
■ Jamie.Robinson
SSN: 309-92-0550
DOB: 03/11/1968
Address: 16334 Bay Meadow Circle,Westfield, IN 46074
■ Jordan-Robinson
SSN: 312-04-8617
DOB: 04/13/1988
Address: 506 West 7th Street,Sheridan, IN 46069
■ Brock Robinson
SSN: 311-08-9423
DOB: 03/09/1990
Address: 407 Shadetree Court,Sheridan, IN 46069
Michael Williamson
Entire check($106.91) should go to James Williamson"J�
■ SSN: 308-44-1607
■ DOB: 08/19/1941
■ Address: 2421 Emerald Pines Lane, Westfield, IN 46074
Any questions, let me know.
Regards,
sore
Sue Wolfgang I Employee Benefits Manager
City of Carmel P- Department of Human Resources
317.571.5550 ® swolfgang@carmel.in.gov
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