177202 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363342 Page 1 of 1
ONE CIVIC SQUARE MATHEW C FRITZ
CARMEL, INDIANA 46032 CHECK AMOUNT: $3,260.00
3069 SUGAR MAPLE COURT
CARMEL IN 46032 CHECK NUMBER: 177202
CHECK DATE: 9/15/2009
DEPARTMENT ACCOU PO NUM IN VOICE NUMBER AM OUNT DESCRIPT
101 5023990 3,260.00 GOLF MEMBERSHIP RFND
2
-.1
a
Internal Medicine of Carmel
11911 N. Meridian St Suite 110 Carmel, IN 46032
(317) 571 -1151 Fax: (317) 571 -0116
September 10, 2009
Re:
MATHEW C FRITZ
3069 SUGARE MAPLE CT
CARMEL, IN 46033
To Whom It May Concern:
Mr. Fritz had cervical disc disease which is exacerbated by golfing and I have instructed him to
stop playing golf until further notice. I would ask that you consider refunding his membership
dues.
Sincerely,
Russell Palmer, MD
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
Purchase Order No.
�u 6 Q 5��� 'T. Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total :3a d
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
�.�07 66AP �ut�s�
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
C.� 1 20 6
S' nature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund