HomeMy WebLinkAbout196807 04/26/2011 CITY OF CARMEL, INDIANA VENDOR: 365256 Page 1 of 1
ONE CIVIC SQUARE MARGARET HALL CHECK AMOUNT: $381.55
CARMEL, INDIANA 46032 10368 DELPHI COURT
FISHERS IN 46038 CHECK NUMBER: 196807
CHECK DATE: 4/26/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 381.55 AMBULANCE REFUND
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JAMES BRAINARD, MAYOR
April 21, 2011
Ms. Margaret Hall
10368 Delphi Ct.
Fishers, IN 46038
RE: INVOICE 9201002427/ D.O.S. 09 /11 /2010
Dear Ms Hall:
Enclosed you will find a reimbursement check in the amount of $381.55. On February
14, 2011 we received a check from you for your ambulance transport on September 11,
2010 in the amount of $381.55. On April 5, 2011 we received a payment from Medicare
for the same ambulance transport in the amount of $305.24. On April 14, 2011 we
received a check from Anthem Blue Cross in the amount of $76.31 for the same
ambulance transport. Since you had previously paid the balance in full, I am issuing you
a refund of $381.55.
If you have any questions, please feel free to contact me at (317) 571 -2605.
Sincerely,
Belk S. Lannan
Y
Billing Administrator
CARNIFL FIRE 'DEPARTNIEI�
STEVEN A. COUTs HEADQUARTERS
TWO CIVIC SQUARE, CARNIEI., IN 46032 OFFICE 317.571.2600, FAx 317.571.2615
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
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.
Payee 1
ll�! Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
Clerk Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
oi-e— IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
20
4 47
Sign t e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund