205642 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 355549 Page 1 of 1
ONE CIVIC SQUARE Y M C A
CHECK AMOUNT: $268.65
CARMEL, INDIANA 46032 615 N ALABAMA ST SUITE 200
INDIANAPOLIS IN 46204 -1359 CHECK NUMBER: 205642
CHECK DATE: 1/1712012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 1726797 268.65 WELLNESS PROGRAM
1/5/2012
YMCA of Greater Indianapolis
the 615 N Alabama St Suite 200
`Q Indianapolis IN 46204 -1359 Invoice No.
F� (317) 266 -9622 fax: (317) 266 -2845 Zl m 1726797
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J►M�/�1CG
Bill to: City of Carmel 317 571 -5850
Attn: Michele Whittington
Human Resources, 1 Civic Square
Carmel, IN 46032 D
JAN 17 2012
YMCA membership fees for the month of
January 2012 B YMCA 4 Employee Employer Type Date of Birth Remarks
n
Brisco, Michael 15 -36029 0.00 11.85 Adult HH (2)
age
1
y
YMCA membership fees for the month
;T January 2012
i
Name YMCA Employee Employer Tvpe Date of Birth Remarks
Subtotals 0.00 268.65
23 employees Total Due $268.65
Please remit to: i
YMCA of Greater Indianapolis Terms: Net 30 days
615 N. Alabama Street
Indianapolis, IN 46204
:i
Additions this period:
Willard, Lindsay 15- 543436 0.00 11.85 Adult HH (2) 1 lJolned 12 -21 -11
Cancellations this period:
None
f
i
i
I
Page 2
VOUCHER NO. WARRANT NO.
ALLOWED 20
YMCA of Greater Indianapolis
IN SUM OF
615 N. Alabama St., Suite 200
Indianapolis, IN 46204 -1359
$268.65
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
21668 1726797 43- 419.80 $268.65
I hereby certify that the attached invoice(s), or
I I
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
Friday, January 13, 2012
Director, HR
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))
01/05/12 1726797 $268.65
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
1 20
Clerk- Treasurer