HomeMy WebLinkAbout168816 02/12/2009 OF CARMEL, INDIANA VENDOR: 353804 Page 1 of 1
4 ONE CIVIC SQUARE KRISTY DELONG CHECK AMOUNT: $19.30
CARMEL, INDIANA 46032 9443 RIDGECREEK CT
iNDPLS IN 46256 CHECK NUMBER: 168816
CHECK DATE: 2/12/2009
DEPARTMENT_ ACC PO NUMBER INVOICE NUMBE AMOUNT DESC RIPTION
101 2323 94.00 REFUND -MED FLEX
301 3910.00 -74.70 HEALTH INSURANCE PREM
Delong
Payroll Elected Deducted Overpaid
1 77.00 30.00 -47.00
2 77.00 124.00. 47.00
3 77.00 124.00 47.00
4 77.00 124.00 47.00
308.00 402.00 94.00
P,rr_ scribed'6y 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.
7 Y Terms
//t/ T 6�2 56 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Del_
O 9oz o 6 3 o 4pe
3
.l
Fq
Total 9
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.
T ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
oz a v
a
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
95!.!YD bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Z 20 .0
Ame
n ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund