170789 04/16/2009 ��cw CITY OF CARMEL, INDIANA VENDOR: 362339 Page 1 of 1
ONE CIVIC SQUARE CITIZENS MANAGEMENT INC
CHECK AMOUNT: $2,100.71
CARMEL, INDIANA 46032 Po aox 620
oN �o HOWELL MI 48844 -0620 CHECK NUMBER: 170789
CHECK DATE: 4/16/2009
D EPARTMENT ACCOUN PO NUM INVOICE NUMBER AM OUNT DESC
302 5023990 SWC0000385 2,100.71 WORKMEN'S COMPENSATIO
Citizens
Management Inc
a�,ny Jnn..,.... t,.,.,..... Citizens Management Inc., I PO Box 620, Howell, MI 48844 -0620 LO55 Fund Invoice
TO: MS. SHELLY M. LINGELBAUGH
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
DATE: 03/3112009
LOSS FUND INVOICE
REFERENCE SWC0000385 AMOUNT DUE
INITIAL DEPOSIT $25,000.00
03/31/2009 BALANCE $22,899.29
AMOUNT DUE $2,100.71
IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL PLEASE CONTACT US AT: 517 540 -3186
PLEASE NOTE: WE ARE FORBIDDEN BY LAW TO ISSUE CHECKS SHOULD YOUR LOSS FUND BECOME ZERO BALANCE
From: 03/01/2009 City of Carmel
Thrw 03/31/2009 Check Register a
Check Check
Number Check Date Claim Numbe DOI Claiman Name Location Pay ee. Amount Type Trans
1181061 03/09/2009 0385 -09 -00052 01/09/2009 Towns, Adam M. Street City of Carmel Community Hospitals Of IN $487.15 Med Check
1181733 03/18/2009 0385 -09 -00135 01/14/2009 Graham, Bruce A. Police City of Carmel Robert A Czarkowski MD $279.78 Med Check
1182468 03i27/2009 0385 -09 -00135 01/1412009 Graham, Bruce A. Police City of Carmel Community Hospitals Of IN $87.08 Med Check
1182469 03/27/2009 0385 -09 -00845 02/27/2009 Molter, Matthew Police City of Carmel Community Hospitals Of IN $509.00 Med Check
1182555 03/27/2009 0385 -09 -00135 01/14/2009 Graham, Bruce A. Police City of Carmel Indiana Health Network $56.06 Exp Check
1182637 03/30/2009 0385 -09 -00135 01/14/2009 Graham, Bruce A. Police City of Carmel Community Hospitals Of IN $321.70 Med Check
1182638 03/30/2009 0385 -09 -00793 02/22/2009 Towle, John R. Police City of Carmel Community Hospitals Of IN $359.94 Med Check
Number of Checks: 7 $2,100.71
Run Date: 03/31/2009 05:20:07 Citizens Management Inc. Run By: AXC654
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
0
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
Citizen's Management Inc Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0,513 SM,0000385 Loss Fund Invoice 1 $2,100.71
Total $2.100.71
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.
20
Clerk- Treasurer
VOUCHER NO WARRANT NO. 09
ALLOWED 20
Citizen's Management Inc.
IN SUM OF
P.O. Box 620
1 10well, MI 4;8844-0620
$2,100.71
ON ACCOUNT OF APPROPRIATION FOR
GENERAL FUND
1205 Administration
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1205 SWC00003B 71 materials or services itemized thereon for
which charge is made were ordered and
received except
20
n
Si nit re
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund