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HomeMy WebLinkAbout201014 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 365641 Page 1 of 1 ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $283.94 CARMEL, INDIANA 46032 HEALTH INFORMATION MANAGEMENT 'pro 2001 W 86TH STREET CHECK NUMBER: 201014 INDIANAPOLIS IN 46260 CHECK DATE: 8/30/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4358200 32848 78.45 SPECIAL INVESTIGATION 1110 4358200 33141 132.70 SPECIAL INVESTIGATION 1110 4358200 35358 72.79 SPECIAL INVESTIGATION St. Vincent Hospital Invoice No Health Information Management 32848 2001 W. 86th Street Indianapolis, IN 46260 317 338 -2216 Tax ID:35- 0869066 Date: 08/12/2009 To: Carmel Police Department Investigations Division 3 Civic Square Carmel, IN 46032 Attn: Lana Howard Duplicate Invoice 737 Days Over Due L J Please include your invoice number on your check. Patient: Christopher Klooz Request No Invoice No Medical Record No Date' Received Date Sent K70721 32848 0000602088 07/15/2009 08/12/2009 Pages /Time Charges Photocopy 97 51.75 If this bill has been paid, please send a copy of the front and back of your cancelled check. Postage 6.70 Certified 20.00 Sales Tax 0.00 Total Billed $78.45 PAST DUE Amount Paid 0.00 Balance $78.45 To ensure proper posting of payments, please send Attn: Health Information Services Department St. Vincent Hospital Invoice No Health Information Management 35358 2001 W. 86th Street Indianapolis, IN 46260 317 338 -2216 Tax ID:35- 0869066 Date: 02/19/2010 To Carmel Police Department 3 Civil Square Carmel, IN 46032 Attn: Det Trent McIntyre Duplicate Invoice 546 Days Over Due Please inciude your invoice number on your check. Patient: Kent J Emry Request No Invoice No Medical Record No Date Received Date Sent E79886 35358 0000360132 01/29/2010 02/19/2010 Pages /Time Charges Photocopy 79 47.25 If this bill has been paid, please send a copy of the front and back of your cancelled check. Postage 5.54 Certified 20.00 Sales Tax 0.00 PS v Total Billed $72.79 Amount Paid 0.00 Balance $72.79 To ensure proper posting of payments, please send Attn: Health Information Services Department St. Vincent Hospital Invoice No Health Information Management 33141 2001 W. 86th Street Indianapolis, IN 46260 317 338 -2216 Tax ID:35- 0869066 Date: 08/28/2009 To: Carmel Police Department 3 Civil Square Carmel, IN 46032 Attn: Det T C Tilson Duplicate Invoice 721 Days Over Due Please include your invoice number on your check. Patient: Richard Flores Request No Invoice No Medical Record No Date Received Date Sent F72344 33141 0002011387 08/05/2009 08/28/2009 Pages /Time Charges Photocopy 290 100.00 If this bill has been paid, please send a copy of the front and back of your cancelled check. Postage 12.70 Certified 20.00 g p Sales Tax 0.00 PAST DUE Total Billed $132.70 Amount Paid 0.00 Balance $132.70 To ensure proper posting of payments, please send Attn: Health Information Services Department VOUCHER NO. WARRANT NO. ALLOWED 20 St. Vincent Hospital Health Information Management IN SUM OF 2001 W. 86th Street Indianapolis, IN 46260 $283.94 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO, ACCT #/TITLE AMOUNT Board Members 1110 33141 43- 582.00 $132.70 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 35358 43- 582.00 $72.79 materials or services itemized thereon for 1110 32848 43- 582.00 $78.45 which charge is made were ordered and received except Thursday, August 25, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER 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 Purchase Order No, Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/01/11 33141 payment for investigative services $132.70 01/01111 35358 payment for investigative services $72.79 01/01/11 32848 payment for investigative services $78.45 1 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 2Q Clerk- Treasurer