HomeMy WebLinkAbout197349 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 365278 Page 1 of 1
ONE CIVIC SQUARE BETSY POPE CHECK AMOUNT: $1,550.00
CARMEL, INDIANA 46032 11230 ROLLING SPRINGS DRIVE
CARMEL IN 46033 CHECK NUMBER: 197349
CHECK DATE: 5/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1,550.00 GOLF REFUND
May 9, 2011
We are refunding Betsy Pope $1550 for her membership purchased in April. Betsy has a
spine issue and unable to play golf per her doctor's orders.
Brian Ballard
PGA Head Golf Professional
Brookshire Golf Club
Internal Medicine of Carmel
11911 N. Meridian St Suite 110 Carmel, IN 46032
(317) 621 -1151 Fax: (317) 621 -1179
May 3, 2011
BETSY J POPE
11230 ROLLING SPRINGS DR.
CARMEL, IN 46033
To Whom It May Concern:
My patient, Ms. Betsy Pope, DOB was seen in my office on 4/18/2011 and diagnosed
with Sciatica and is advised to not play golf for 4 -6 weeks.
Sincerely,
Russell Palmer, MD
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev, 7995)
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
D i" Purchase Order No.
,Z 30 �f� AJ� �C S Terms
2 ter- Z-/ U3 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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
0 ---7
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
0 2o 7 O/ 6 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
/0 20
Aq
Si ture
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund