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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 t EL Ci 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