HomeMy WebLinkAbout206733 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 366062 Page 1 of 1
ONE CIVIC SQUARE RICHARD LANCASTER
CARMEL, INDIANA 46032 9276 TAMARACK DRIVE CHECK AMOUNT: $1,200.00
INDIANAPOLIS IN 46260
CHECK NUMBER: 206733
CHECK DATE: 2128/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1207 1,200.00 MEMBERSHIP REFUND
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OF oPV'
Brookshire Golf Course
12120 Brookshire Parkway
Carmel IN 46033
Ph. 317.846.7431
Fax 317.846.9980
www.brookshiregolf.com
February 24, 2012
Mr. Richard Lancaster:
We are sorry to here you will be unable to use your membership this year due to
your illness. We are issuing a refund in the amount of $1200.00 to you. If you have any further
questions or needs please feel free to contact me.
Sincerely
Pam Lister
Office Administrator
Brookshire Golf Club
12120 Brookshire Parkway
Carmel, IN 46033
Direct: 317- 846 -7422
IU Health Physicians
Suzanne Bielski, MD
Sean Keller, MD
Debra Moreland, MD
Catherine Rupp, MD
Jeffrey Wheeler, MD
Letter
Patient: RICHARD B. LANCASTER MRN: 2018943
9276 TAMARACK DR Age /DOB: 80 /Aug 15, 1931
INDIANAPOLIS, IN 46260
Home: (317) 575 -1068
Encounter Date: Feb 21 2012 3:13PM Work:
To Whom It May Concern:
I am Mr. Lancaster's personal physician. He has recently developed worsening arthritis, a heart attack, and severe
orthopedic injuries. Due to all of these issues I have unfortunately instructed him to limit golfing. Please consider
refunding his golf course membership.
Electronically signed by:JEFFREY A WHEELER M.D. Feb 22 20 12 5:26PM EST
Internal Medicine Pediatrics General Information
Saxony Hospital T 317.944.4000
13100 E 136th Street, Suite 1200 I T 888.944.DOCS (3627)
Fishers, IN 46037
j
T 317.678.3100 F 317.678.3108 iuhealth.org /physicians
Printed By: JEFFREY A WHEELER 1 of 1 2/22/12 5:26:26 PM
VOUCHER NO. WARRANT NO.
ALLOWED 20
Richard Lancaster
IN SUM OF
9276 Tamarack Drive
Indianapolis, IN 46260
$1,200.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#! Dept. INVOICE NO. ACCT #(rITLE AMOUNT Board Members
x-
1207 I j '70 /5 I $1,200.00 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
Friday, February 24, 2012
Director, BrookshM Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
1
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
D ate Number (or note attached invoice(s) or bill(s))
02/24/12 Refund Membership $1,200.00
t hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with 1C 5- 11- 10 -1.6
20
Clerk- Treasurer