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205578 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 254452 Page 1 of 1 ONE CIVIC SQUARE PURDUE UNIVERSITY CARMEL, INDIANA 46032 LYNN HALL OF VETERINARY MEDICINE CHECK AMOUNT: $179.00 625 HARRISON STREET CHECK NUMBER: 205578 WEST LAFAYETTE IN 47907 -2026 CHECK DATE: 1/17/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4357600 3014821 179.00 ANIMAL SERVICES Mail checks or certified funds to: Personall make payments at: Contact us at: PURDU Purdue University Bursar's Office TEL 765 494 -9459 U N I v H x s I T Y University Collections Office Hovde Hall FAX 765 494 -9154 24025 Network Place Monday through Friday ar @purdue.edu Chicago, IL 60673 -1240 8:30am -noon or 1- 4:30pm www.purdue.edu /uco INVOICE *AUTO *3 -DIGIT 460 T5 P1 Page 1/2 Carmel Police Dept Invoice Date: 01/03/12 3 Civic Sq Amount Due: 179.00 Carmel IN 46032 -2584 Business Partner: 3014821 1�1��1�111111��1�1��1�111111��111��11�111 Posting Document No_ Description of Invoice Due Date Amount Date 12/28/2011 530336 S- 753613 -9 12/19/11 Ben 01/25/2012 $179.00 Total $179.00 Please see rev side of thi notic for im portant info `Detach and return cower portion `with payment. Page 2/2 'A IMPORTANT INFORMATION REGARDING YOUR ACCOUNT To better serve you, if you have a specific question regarding a charge from one of the areas listed below, please contact their direct number for information. Student Health Center Charge (765) 494 -1677 Other Current Charges (765) 494 -9459 Conference /Continuing Education Charge (765) 494 -7209 Past Due Charges (765) 496 -6599 Veterinary Teaching Hospital Charge (765) 496 -6093 Ag. County Extension Ofc. (765) 494 -8514 Library Charge (765) 494 -0369 N TO STU CUST STUDENT ACADEMIC RECORDS WILL BE AUTOMATICALLY ENCUMBERED I CHARGES ARE NOT PAID BY THE ORIGINAL DUE DATE. Please be sure to include your Business.Partner number in the memo section of the wire transfer for proper credit. Credit Card Pa Contact (765) 494 -9459 or reference the following for payment instructions. <htt /www. Purdue. edu/ uco /Accts /paay ment _o ptions. htm> Returned Checks _Drafts� All returned checks, drafts, or orders are subject to the maximum service charge allowed by law. Non- Payment and Collection Costs: In the event of non payment of this invoice, the University shall be entitled to all additional costs refer- enced in Indiana Code 21- 14 -2 -11, which states "Notwithstanding any other law, a state educational institution (as defined in IC 21- 14 -2 -1), in collecting amounts owed it, may, in the event of default and referral to an attorney or collection agency, add to the amount collected the follow- ing: 1) The amount of attorney's fees incurred in the collection of the debt. 2) The amount of collection agency fees incurred in the collection of the debt. 3) The amount of court costs incurred in the collection of the debt." Any judgment entered shall be without relief from valuation and appraisement laws. The parties agree that the exclusive venue for any dispute resolution brought under this Invoice shall be the courts of Tip- pecanoe County, Indiana. In Case of Errors or Questions About Your Account: If you need additional information about a transaction or invoice on your statement, please contact us at 765 494 -9459 oror@ purdue.edu <mailto:ar purdue.edu If you think your statement is wrong, you must write to us on a separate sheet of paper and send to Purdue University, Accounts Receivable, Schleman Hall of Student Services, Room 350, 475 Stadium Mall Drive, West Lafayette, IN, 47907 -2050. We must hear from you no later than 60 days after we've sent the first statement on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter please provide us with the following information: Your name, Business Partner number and telephone number The dollar amount of the suspected error. Describe the error or invoice and explain why you believe it is an error. If you need more information, describe the item in question. Please sign and date the correspondence. You do not have to pay any amount in dispute while we are investigating your question, but you are still obligated to pay the parts of your state- ment that are not in question. While we investigate your question, we cannot report you as delinquent on the disputed item or take any action to collect the amount in dispute. We must acknowledge your letter within thirty (30) days unless we have corrected the error by then. Within ninety (90) days, we must either correct the error or explain why we believe the charge is correct. Plg6a.) PURDUE U N I V E R S" I[ T Y VETERINARY TEACHING HOSPITAL Invoice Visit: S- 753613 -9 Carmel Police Department Patient Name: Ben 3 Civic Square Patient ID: 753613 Carmel, IN 46032 Admission Date: 12/19/2011 10:48:34 AM Discharge Date: 12/19/2011 2:00:00 PM Reason: recheck lumbosacral Administrative Fee Units Charge Credit Sub -Tota 12/19/2011 Bio- Security Fee 1.00 $4.00 $0.00 $4.00 Sub- Totals: $4.00- $0.00 -$4:00 Anesthesia Units Charge Credit Sub -Total 12/19/2011 Anesth Sedation With Reversal 1.00 $45.00 $0.00 $45.00 Sub Totals: $45.00 $0.00 $45.00 D iagnostic Imaging U Charge Credit Sub -Total 12/19/2011 Consultation- radiology 1.00 $37.00 $0.00 $37.00 12/19/2011 Radiographs- diagnostic 2.00 $60.00 $0.00 $60.00 Sub Totals: $97.00 $0.00 $97.00 Professional Services Units Charge Credit Sub -Total 12/19/2011 Office Visit, Recheck 1.00 $33.00 $0.00 $33.00 Sub Totals: $33.00 $0.00 $33.00 Charged Credits Sub -Total $179:00 ;0:00 $179:00 We appreciate your feedback. We invite you to complete a Client Satisfaction Survey online at http:// www. vet.purdue.edu /vth /survey.html. Thank you for choosing the Veterinary Teaching Hospital at the Purdue School of Veterinary Medicine. School of Veterinary Medicine Lynn Hall of Veterinary Medicine 62514arison Street West Lafayette, IN 47907 -2026 Printed: 12/19/2011 04:44 PM Small Animal Hospital (765) 494 -1107 Large Animal Hospital (765) 494 -8548 Page 2 of 2 OEM I\ 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)) 01/03/12 3014821 animal services Ben $179.00 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. WARR NO. ALLOWED 20 Purdue University Lynn Hall of Veterinary Medicine IN SUM OF 625 Harrison Street West Lafayette, IN 47907 -2026 $179.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1110 I 3014821 I 43- 576.00 I $179.00 1 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 Thursday, January 12, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund