170174 03/16/2009 CITY OF CARMEL, INDIANA VENDOR: 355549 Page 1 of 1
0 ONE CIVIC SQUARE Y M C A CHECK AMOUNT: $233.70
CARMEL, INDIANA 46032 615 N ALABAMA ST SUITE 200
,w INDIANAPOLIS IN 46204 -1359 CHECK NUMBER: 170174
CHECK DATE: 311612009
'V DEPARTMENT ACCOUNT. PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4341980 1020377 233.70 WELLNESS-PROGRAM
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YMCA of Greater Indianapolis 3/3/2009
615 N Alabama St Suite 200
Indianapolis IN 46204 -1359 Invoice No. 1020377
(317) 266 -9622 fax: (317) 266 -2845
rs INVOICE
Bill to: City of Carmel (317) 571 -5850
Attn: Michele Whittington
Human Resources
1 Civic Square
Carmel IN 46032
YMCA merr bership fees for the month of
March 2009
Name YMCA Employee Employe Type Date of Birth Remarks
Allen, Brad 07- 167698 0.00 10.95 Adult HH 2
Subtotals 0.00 233:70
21 employees Total Due $233.70 -/0 p 1
Please remit to: .4
YMCA of Greater Indianapolis Terms: Net 30 days
615 N. Alabama Street "0/ 3.
Indianapolis, IN 46204 d
7 4 n- i
Page 1
t�
YMCA membership fees for the month of
March 2009
Name YMCA Employee Employer Type Date of Birth Remarks
Additions this period:
Keaton, Anthony 15 -15950 0.00 10.95 1 Adult HH 2 lJoined 2 -1 -09
Cancellations this period:
None
Page 2
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
YMCA Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1020377 IVI%JJILIII membership Maich 2009 $2.33.70
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER f0%W 9WARRANT NO.
ALLOWED 20
IN SUM OF$
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ON ACCOU F PROPRIATION FOR
Ll
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I 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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund