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CITY OF CARMEL
ZONING/ DEVELOPMENTS RECEIPT
********************************************************************************
PARCEL ID
PROJECT
RECEIPT #
RECEIPT DATE
1609360002004005
08020007
27534
03/04/2008
ADDRESS
PRINT DATE
PRINT TIME
OPERATOR
COPY # :
CASH DRAWER:
1402 CHASE CT
03/04/2008
08:52:21
scoy ~
4
PZ
RECEIVED BY
REC'D. FROM
TESTI06.1
UDF 106.2
NOTES : CLARIAN/VELOCITY SPORTS SGN
scoy
CLARIAN HEALTH
FEE ID
UNIT QUANTITY
AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- -~~------- ~~--------
572 .50 O. 00 572.50 0.00
---------- --~------- ---------- ---------~
572 50 0.00 572 .50 O. 00
Z-HO-COM
FLAT RATE 1.00
TOTAL PROJECT :
METHOD OF 'PAYMENT
AMOuNT
NUMBER
CHECK
TOTAL RECEIPT :
572.50
412915
572.50
FEB~19-2008 rUE 12:38 PH
City'of Carmel
One Civic Square
carnlel, IN 46032
31/'-571-2417 lax 317-571-2426
"'"
State IN
ZIP 46032
------------_.~.-
~.~.
~_~------P.escrip-tiCln~---- ", I
Hearing Officer Variance"fee (Docket #08020007 V) , -."
PIBa",e fBlurn one copy with payment.
Please make check payab~Q to:
City 01 Carmel
! and mail 10 the attention:
City of Carmel, DOCS
One Civic Squaro
Carmci, 1N 46032
Payment Details
o Cash
o Check
- ~-,-------'" -,-~--
FAX NO.
Invoice No.
p, 02
107 .
~ INVOICE' ~
Dale
Order No.
'Rep
FOB
E13/2008 ,_....:.
-----.
Unit Price
-'-
-,_..~,_.-
$572.50
Torq
-. $572.50 I
I
Total
_ $572.50_
,_._$o.g~,~_
Customer
Name _~Iariah Hea!th I V~locity Sports Signage . - .--"
Address 1402 Chase Ct.
City .farmel__
Phone
r'fle. Use only
City of Ci!lrmef, DepartmeM of Community services
~
R~ceived Time Feb, 19. 12: 15PM
J
Vendor Payment Request
Page I of 1
)\1 Clarian Health
nn MethcdisHU.Riley
This form 15 not to be used to payor reimburse employees
Vendor Payment Request
Due Date: r~2-=-22-08
Date: 102" 19-08
Number: 17597
i Attach all.supporting I
' documents
Remit to:
Address
City of Carmel
One Civic Square
Payee Information
l.Js payment for Services, Awards, Rents, Royalties or Medical Service~
(', Yes Provide Taxpayer Identification Number requested ill question 2
below.
~ No Go to question 3 below
2. Enter payee Taxpayer Identification Number, if required.
Social SeCllliLy No. [==.==] OR Employer TO Number[='~=~=]
3 Is payee a non residenl alien?
C> Yes Please comply with section II on reserve side.
@, No Go to next section of form.
Name
City
Cannel
State
Indiana
Zip 46032
S_~ec!a!~n:!~~_~li_~_n:>: ________ m _ _.~.._~.~__...____m.M___. .___.__. .....__.__._.___....._............... _....jlU.Bnl'.I.~U...UX_. _..._..__
SWII.Ui.UI 9,
02/2f)f200U 'I
I ,
. . I !
.............__._._____~..m.._'_'........._..______._.___.__........_.._..__._.._____...__~_~_e._..~....~~_~.. e_ ~ _._~_._......_._._.....___.._ .__......... .......~..._ ....... e' .~~~.__.._ i:J
Company Paying Expense(Please check onc)
Company 10 Company 20 Company 30
I? 10 CHP C 20 MMGP c- 30 MOHC
C 15 Clarian C 23 MMG U 34 UCON
Home Care C 2S HMS
Number of lines to enter: L_~~...:..J f. Update I
Description Accounting Unit
-~..~,.~-
Hearing officer variance fee for 1010] 5
docket 080200007V
Company 40
~ 40 M.Plan
C: 45 f:ncore-PPO
C 60 HealthNet
C' 80 EMGI
1100 Methodist
Health Foundation
C' Other 1..._.__ . ..0_ ._
GiL Account
Amount
731 ]0
572.50
Payment Total
572.5
r---'-
Prepared by: JAimee Lacey
-.- ""1
.- -. j
Depanment Phone #: r962-~_5~3
-~ ]
r (we) have reviewed the request and underlying documentation and hereby certify that it IS appropriate use of funds (either
restricted or unre$tricted) consistent with the intern and written guidelines which have been established for the use of those
funds and the tax-exempt purpose of the Organization. I am authoriz.ed to approve expenditures from this Fund or Cost Center.
r;-..-..--.-.".......... .....-...- ........~..............-.-...-..-- ----..--..~
Print Name: ,Sheila Ogde i
L_ ----~,~---"......~.......~_...i
.---.-----~.----.- . -.- "_,_. __ c..-,___'c__~r~__________._'. _, _._.__._"_... ____.._,
Title: !Adm,nistrative Director __._.. __.I
Signature:
~~/.LJ ic-~
. f)
Date: [:3_:iQ_~Q~~g
http://Plll se .c!arian.org/F onm/html/vendorPa ymentReq uestPrint.j sp
2/19/2008