HomeMy WebLinkAbout327611 07/18/18 ✓d.Np"?s
&y` ''�� CITY OF CARMEL,INDIANA VENDOR: 354969
1- 'e. .•! ONE CIVIC SQUARE MATTHEW HOFFMAN CHECK AMOUNT: $ 400.00*
•Si i is �Qa 5808 SEDGEGRASS CROSSING CHECK NUMBER: 327611
°`4.. ,/�a CARMEL, INDIANA 46032 46033 IN CARMEL
.tw.ie„2, CHECK DATE: 07/18/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 07:10.18 400.00 OTHER EXPENSES
VOUCHER NO. WARRANT NO. • Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 354969
MATTHEW.HOFFMAN •
IN SUM OF$ CITY OF CARMEL
5808 SEDGEGRASS CROSSING 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
Payee
•
$400.00
•
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
07.10.18 50-239.90 $400.00 I hereby certify that the attached invoice(s),or 7/10/18 07.10.18 Si-Annual Health Savings Account $400.00
301 301 301 301 Contribution
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
p
Thursday,July 12,2018
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
I^
City of Cannel 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.
• Clerk-Treasurer: Please return check to Human Resources for distribution.
Plan Participant/Payee:
Matthew Hoffman
5808 Sedgegrass Crossing
Carmel,IN 46033
Amount: $400.00
Fund: Medical Escrow Fund (301)
Date: July 10,2018
•
Sub Toted To
JUL 11 2018
' Clerk Treasurer