178922 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 355549 Page 7 of 1
II Q� ONE CIVIC SQUARE YMCA CHECK AMOUNT: $200.85
CARMEL, INDIANA 46032 615 N ALABAMA ST SUITE 200
INDIANAPOLIS IN 46204 -1359 CHECK NUMBER: 178922
CHECK DATE: 10/2812009
Q EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4341980 1160476 200.85 WELLNESS PROGRAM
I Zit
YMCA of Greater Indianapolis 10/2/2009
615 N Alabama St Suite 200
Indianapolis IN 46204 -1359 Invoice No. 1160476 i
(317) 266 -9622 fax: (317) 266 -2845
INVOICE
Bill to: City of Carmel 317- 571 -5850
Attn: Michele Whittington
Human Resources, 1 Civic Square
Carmel, IN 46032
YMCA membership fees for the month of
October 2009
Name YMCA Employee Employ Type Date of Birth Remarks
Allen, Brad 07- 167698 0.00 10.95 Adult HH 2
Subtotals 0.00 200.85
19 employees Total Due $200.85
Please remit to:
YMCA of Greater Indianapolis Terms: Net 30 days
615 N. Alabama Street
Indianapolis, IN 46204
i
Additions this period:
Page 1
YMCA membership fees for the month of
October 2009 i
Name YMCA Employee Employer Type Date of Birth Remarks
None
Cancellations this period:
Schlae el, Courtney 12- 202628 1 0.00 1 10.95 1 Adult HH 2 lCancelled 10 -1 -09
Page 2
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
Total
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ll ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
411 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
20
i
Si ture
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund