163410 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 7
s, kl ONE CIVIC SQUARE ST VINCENT HOSPITAL
o CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $218.55
8401 HARCOURT ROAD CHECK NUMBER: 163410
INDIANAPOLIS IN 46260
CHECK DATE: 913/2008
DEPARTMENT ACCOU PO N UMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4122100 218.55 DISABILITY INSURANCE
I
9--; VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
08/08/08 5- 20386066 218.55
*CARMEL CLAY PARKS RECREATI
1411 E 116TH STREET
LYNN RUSSELL
CARMEL,IN 46032
Please enclose top portion with payment
Rate_:_- _2_._3.5___N.umber_ -o -f _Employees 31
ACCT 5- 20386066 PATIENT: *CARMEL CLAY PARKS CHG AMT PAY /ADJ BALANCE
INVOICE 052393387
EMP PROVIDER
07/08/08 JULY 2008 72.85
07/08/08 AUGUST 2008 72.85
07/08/08 SEPTEMBER 2008 72.85
INVOICE BALANCE: 218.55
Doewpk_ Em���y C L Rax
rr
P.G.0 PorF
Q.L0 DI la d
SURA110E, RECEIVED
Pumhow AUG 1 1 2008
BY:
Account 0 -30 days 31 -60 days 61 -90 days >90 days Balance Due
5- 20386066 0.00 218.55 0.00 0.00 218.55
PAGE: 1
ST VINCENT EMPL. ASST. M F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317- 338 -4900
INDIANAPOLIS IN 46260
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
295900 St. Vincent Empl. Asst. Program Terms
8401 Harcourt Road Date Due
Indianapolis IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
818108 52393387 Employee Assistance Program 3rd Qtr 218.55
Total 218.55
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
295900 St, Vincent Empl. Asst. Program Allowed 20
8401 Harcourt Road
Indianapolis IN 46260
In Sum of
218.55
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept
1125 52393387 4122100 218.55
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
18 -Aug 2008
Signature
218.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund