168250 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 355549 Page 1 of 1
ONE CIVIC SQUARE Y M C A
CARMEL, INDIANA 46032 615 N ALABAMA ST SUITE 200 CHECK AMOUNT: $189.00
INDIANAPOLIS IN 46204 -1359
CHECK NUMBER: 168250
CHECK DATE: 1121/2009
DEPARTMENT ACCOUNT PO NUMBE INVOICE N AMOUNT DESCRIPTION
1201 4341980 979613 189.00 WELLNESS PROGRAM
C�
i
YMCA of Greater Indianapolis v5/2oo9
615 N Alabama St Suite 200
Indianapolis IN 46204 -1359 Invoice No. t 9 9 613
(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
January 2009
Name YMCA Employee Employer Type Date of Birth Remarks
Allen, Brad 07- 167698 0.00 10.95 Adult HH 2
Subtotals 0.00 189.90
18 employees Total Due $189.90
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
January 2009
Name YMCA Employee Employer Type Date of Birth Remarks
None
Cancellations this period:
Cromlich, Mark 15 -17337 0.00 10.95 1 Adult HH 2 Cancelled 12 -31 -08
Page 2
F�?.scribed 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))
189.90
Total
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 X1. 116109 WARRANT NO.
napo is
ALLOWED 20
Alabama Street, Ste 200 IN SUM OF
Indianapolis IN 46204 1a '42
$189.90
ON Accou��NERA ON FOR
L FUND
1201 Human Resources
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify hat the attached invoice(s), or
DEPT. y y
1201 979613 19_ 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
Sig ure K/o
itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund