HomeMy WebLinkAbout197428 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 365284 Page 1 of 1
ONE CIVIC SQUARE ARTHUR WATERS
0 CHECK AMOUNT: $78.93
CARMEL, INDIANA 46032 2961 MARALICE DRIVE
CARMEL IN 46033 CHECK NUMBER: 197428
CHECK DATE: 5/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 78.93 OTHER EXPENSES
0 ®0 0 ®0 0E) 0.
i
CITY `OF ARMEL
TAMES BRA.TNARD, MAYOR
April 28, 2011
Mr. Arthur Waters
2961 Maralice Dr.
Carmel, IN 46033
RE: INVOICE #201002544/ D.Q.S. 09/23/2010
Dear Mr. Waters:
Enclosed you will find a reimbursement check in the amount of $78.93. On February 15,
2011 we received a check from you for your ambulance transport on September 23, 2010
in the amount of $78.93. On April 26, 2011 we received a check from Anthem Blue
Cross in the same amount for the same ambulance transport. Since you had previously
paid the balance in full, I am issuing you a refund of $78.93.
If you have any questions, please feel free to contact me at (3 17) 571 -2605.
Sincerely,
B cky S. Lannan
Billing Administrator
CARNIFI, Fmi Di1 t R rNwN T
STY--,MN A. COUTS HEADQUARTERS
TWO CIVIC SQUARF, CARNIFL, IN 46032 OFFICE 317.571.2600, FAx 317571.2615
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
(rUa-VeS Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
e 41
/f 4
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 n 20
�U IN SUM OF 72 9 3
7 y, 92
ON ACCOUNT OF APPROPRIATION FOR
e—
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
MAY -.g. x;0.11
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund