179078 11/10/2009 CITY OF CARMEL, INDIANA VENDOR: 360618 Page 1 of 1
ONE CIVIC SQUARE STEPHANIE MARSHALL
CARMEL, INDIANA 46032 578 TULIP POPPLUR CREST CHECK AMOUNT: $320.02
CARMEL IN 46033 CHECK NUMBER: 179078
CHECK DATE: 11/10/2009
DE PARTMENT ACCOUNT PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
-902 4347500 283.38 INS MARSHALL
902 435900.3 36.64 FESTIVAL /COMMUNITY EV
i
0 MALIA #206
VSS E. 126TH ST. cbsn"
r• t (JAR 1EL IN 96033
I l`�'~_ L'it )H49' 9:572
U3-16 CASTLE r QN TN
1 r- MEMBER
i x 1 Hr; hil1 11. "r
ells i 11111 It r1W11,1 `il.�ot:
1t 3-46 C A S T L_ E T O N T N E 31423 COOKIES 24CT 6.49
s x* Hari Ii Fl l 1 9. 'J r
MEMBER #111 769670644 VF TOTAL 6�.49
E 34423 COOKIES 2.467 6.49 ��J I 1 I. SWIPED
SED
I;F1RMki Ih it:�i;;S rv�v,
TOTAL �s1� I i 5e9 002432 APB. 013$91
VF EFT / 6.49 EFT / ResP: AA
Chilli Tran ID #::928220003000
SWIPED r i I u r 1 0 I' Merchant Id 99034611
10/09/09 19 PIN USED
Seq# 000910 App# 015969 1 IM t M 1 m 1 1 APPROVED PURCHASE
EFT /DEBIT Resp: AA AMOUNT: $6.49
Tr•an ID 928220019000 RLF 01 1-1
Merchant ID 99034611 0346 202 0000000202 0221
v IF ii_II I i 17 9 r
APPROVED PURCHASE �:i c3o
AMOUNT: $6.49 CHANGE'. .00
0346 204 0000000204 0188 r l l t [I1 I, 1 1 I r r1 I] 1_ II
TOTAL NUMBER OF ITEMS SOLD m 1
ii':) Ii 1 9 L 113 CASHIER: SCO LANE #202 REG# 202
CHANGE .00 i[ilLel%l�'X*Y 19:20 0346202 0221 202
THANK YOU!
TOTAL NUMBER OF ITEMS SOLD i P Lr E,R S E COME AGAIN!
CASHIER:�SCO LANE #204 REG# 204
19:26 0346204 0188 204 1li 1`1:11) 1 11k Iillr:l Ab I1 1 I' M111.111
THANK YOU! r1111i; i [:fl;lilf.:l� wily Fil_Etil`i X THAN! YOU
F='l_EASE COME AGAIN'.
*For° Us i ns CQITCO*
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Page 7 of 8
540002322
Daily activity on your account
r 1 3 14.97- POS PURCHASE
/POS PURCHASE TERMINAL 11429601
O'MALIA FOOD MARKS T #2 CARMEL IN
10 -09 -09 7:51 PM SEQ 01448300
ct 13 6.49- POS PURCHASE
POS PURCHASE TERMINAL 99034611
COSTCO WHSE #0346 CASTLETON IN
10 -09 -09 4 :20 PM SEQ 01389100
O 13 6.49- POS PURCHASE
POS PURCHASE TERMINAL 99034611
COSTCO WHSE #0346 CASTLETON IN
10 -09 -09 4:26 PM SEQ 01596900 3,080.59
Overdraft/Return Item Fees
Return item fees for this statement period $0.00
Return item fees for this calendar year $0.00
Overdraft fees for this statement period $0.00
Overdraft fees for this calendar year $0.00
Thank you for banking at M &I MARSHALL ILSLEY BANK member FDIC.
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Page 8 of 8
To Help Balance Your Account Your checkbook is in balance if line A agrees with line B.
Checkbook If your adjusted checkbook and bank statement balances do not agree:
balance
statement date Review last month's statement to make sure any differences were corrected.
V/ Check additions and subtractions in your checkbook.
Add Interest Compare the amount of each check and deposit on this statement with the
credited and other amount recorded in your checkbook.
dep yet entered in osits made but
not Make sure all outstanding checks have been listed, including those that may not
your checkbook. have been paid from the previous statement.
Make sure that any electronic fund transfers or automatic payments are
recorded in your checkbook.
Important Information
How Your Finance Charge (If Any) Is Calculated If this statement includes billing
Subtotal information regarding a personal line of credit, the finance charge for each statement
(loan) period is calculated by applying the applicable daily periodic rate(s) to the daily
balances (including current transactions). To get daily balances, we take the beginning
principal balance of your account each day, add any new loans or charges and subtract
any payments or credits. Then, we multiply the daily balance each day of the statement
Subtract service period by the applicable daily periodic rate(s). We then add u all of these daily finance
charge and other charges to get your total finance charge. If there is only one (11) daily periodic rate
deductions not during the statement period, the finance charge may also be verified by multiplying the
previously average daily balance by the number of days in the statement period and multiplying
entered In your
checkbook t h e result by the applicable daily periodic rate.
balance. When Vour Payments Are Credited Payments received during regular banking hours
at all of our full service offices will be credited on the same banking day. Payments
received at other locations or after regular banking hours may be credited on the next
banking day.
Subtotal In Caste of Errors or Questions About Your Electronic Transfers If you think your
staternent or receipt is wrong, or you need more information, please call us toll -free at
Ad1justed 1- 888 464 -5463 or write us at P.O. Box 622, Milwaukee. WI 53201 -0622 as soon as you
checkbook can. We must hear from you no later than 60 days after we sent you the FIRST
A
balance statement on which the problem or error appeared.
1. Tell uS your name and account number.
2. Describe the error or transfer you are unsure about, and explain as
Statement clearly as you can why you believe it is an error or why you need
ending balance more information.
3. Tell us the dollar amount of the suspected error.
We will investigate your complaint and correct any error promptly. If we take more than
V 10 business days to do this, we will credit your account for the amount you think is in
Add deposits error, so that you will have use of the money during the time it takes us to complete our
made but not investigation.
shown on this
statement. In Case of Irregularities on Checks or This Statement You must notify us within 30
days alter the date we mailed or made statements or items available to you of any
unauthorized or missing signature or alteration on a check, or within 60 days in the
case of unauthorized or missing endorsements, improper charges or other account
problems. You are precluded from asserting legal action against us unless you have
given us notice as provided above and also initiated legal action within 180 days after
Subtotal we mailed or made statements or items available to you.
In Case of Errors or Questions About Your Personal Line of Credit (Your Billing Rights
Summary) If you think your staternent is wrong, or you need more information about a
transaction on your statement, write us at the address on the front of your statement as
List and subtract soon as possible.
checks issued We must hear from you no later than 60 days after we sent you the first statement on
and withdrawals which the error or problem appeared. You can telephone us, but doing so will not
made but not reserve our rights.
hown on this P Y 9
statement. In your letter, give us the following Information:
1. Your name and account number.
2. The dollar amount of the suspected error.
3. Describe the error and explain, if you can, why you believe there is an
error. If you need more information, describe the item you are unsure
about.
You do not have to pay any amount in question while we are investigating, but you are
still obligated to pay the parts of your bill that are not in question. While we investigate
your question, we cannot report you as delinquent or take any action to collect the
amount you question. If you have authorized us to pay your minimum monthly payment
automatically by charging your deposit account with us, you can stop the payment on
any amount you think Is wrong. To stop the payment, your letter must reach us three
business days before the automatic payment is scheduled to occur.
Subtotal Loss or Theft of Your M &I Bank Card (debit card) To report the loss, theft,
disappearance or suspected unauthorized use of the card or any disclosure of
Adjusted the PIN, call 1- 888 464 -5463 anytime, 24 hours a day.
statement
balance LQUAl HUnI w
Call TDD Hearing Impaired 24 hours a day at 1 -800- 236 -8823 LENDER
Elite Rewards
Banko America
Premred for RICHARD C MARSHALL JR October 2009 Statement
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Credd Line: $
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MARSH 4014 CARMEL IN 09/28 09/25 0954 5372 8.69
ELITE REWARDS NOW OFFERS YOU A NEW WAY TO SAVE COMBINE POINTS AND DOLLARS TO
GET YOUR FAVORITE MERCHANDISE AND GIFT CARDS AT A DISCOUNT, USING AS LITTLE AS
3,500 POINTS. VISIT EUTEREWARDS.COM TO EXPLORE ALL OF THE GREAT BENEFITS AND
BE SURE TO USE YOUR ELITE REWARDS CREDIT CARD FOR ALL OF YOUR HOLIDAY PURCHASES
PAY YOUR BILL QUICKLY WITH THE PAY BY PHONE SERVICE. CALL 1.866297.9258 TO
USE THE AUTOMATED SERVICE OR DISCUSS OTHER PAYMENT OPTIONS.
RECEIVE $10 OFF YOUR FIRST 20 LB, GIFT BOX OF FLORIDA CITRUS. REG:$36.95,
INTRO PRICE :$26.95 S&H AL'S FAMILY FARMS, 1.888231.2450 DEPT. 113
ENJOY SPECIAL DISCOUNTS AT HERTZ.COM WHEN YOU USE CDP# 160018.
Pf Corresponding Annual APR Balance Subject to
Category Transaction Types Daily Prriodic Rate Percentage Rate Type Finance Charge
Balance Transfers 0.021644% V 7.90% S $0.00
Offer HXPR -GKJBB BT, CB, DB 0.016411% 5.9996 P $0.00
Cash Advances 0.068466% V 24.99% S $0.00
Purchases 0.021644% V 7.90% S $0.00
Annual Percentage Rate for this Billing Period: See Corresponding
(Includes Periodic Rate Finance Charges and Transaction Fee Finance Charges that results in an APR which exceeds Annual Percentage
the Corresponding APR above.) Rate Above
APR Type Definitions: Promotional Transaction Types: BT Balance Transfer, CB Check treated as Balance Transfer, DB Direct Deposit treated as Balance
Transfer; Daily Interest Rate Type: V= Variable Rate (Interest Hate may vary); APR Type: S= Standard APR (APR normally in effect), P_ Promotional APR (APR for
limited time on eligible transactions)
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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 1,,
ax s r o Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0 -y'-0 9
b
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.
U 1 ALLOWED 20
�f c-ph n e �tJ1 S I1Gt IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
INVOICE NO. ACCT #!TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
0 Z 9.0 bill(s) is (are) true and correct and that the
�0 y 9 materials or services itemized thereon for
90 Z Y� which charge is made were ordered and
U Z received except
X220 d9
.1
Direc Por g 8 6raVons
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
R -6rd Marshall, Jr. SVP Worldwide COBRA Coupon #5 September/2009
ic
Coverage Tier Period Premium
BCBS HDHPIHSA Medical Plan Employee Family 09/01/2009 fV2009 310.68
Delta Dental Plan Employee Family 09/01/2009 09 22.71
Comments Notes: Subtotal-. $333.39
Amount Paid:
Total Due- $333.39
Return this Coupon and Your Payment to: Coverage for: Due Date: 09/01/2009
Medcom Richard Marshall, Jr.
P.O. Box 10269 Total Enclosed:
Jacksonville, FL 32247-0269 578 Tulip Poplar Crest
Carmel, IN 46033 Make Check Payable to:
Medcorn
Clip Coupon Here and Return with Your Payment
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"'If have any questibns;�con'cerning
our. account, cus
Auto" tedBanktine (800) 565 -3512
usa .ANK
Live Personal Banker (800) 357 6298 lam 9pm CST M F
r`i={Yrndr t x..e,<ti; ixsr'rtr;sy =c�r:..�i.Y. Fax (8j7) 851 7041 R2
A Division of Webster Bank NA. Internet Banking' :v+ww hsatiankcom.
P.O. Box 939 Mail HSA Bank '605 N BthStn�et Suite 320 Sheboygan WI 53081',
Sheboygan, WI 53082 -0939 a matt- askus�hsabartkc6rn
Para uo representante en espafio► por favor llamar aI 866 357 6232
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o Richard C Marshall Jr P 106 €4,4Jd:S3
a 578 Tulip Poplar Crest
Carmel, IN 46033
tv t.L'T<•La n >,�.'P'° -,ta1� Nom" ww
#94sa HSA ACCOU K.
BALANCE LAST STATEMENT 08/31/2009 4,496.53
DISTRIBUTION/WITHDRAWAL CHECK #104 333.39 09/10/2009 4,163.14
RATE CHANGE OLD 1.24% NEW 0.99% 09/18/2009 4,163.14
INTEREST PAID 3.99 09/30/2009 4,167.13
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ANNUAL PERCENTAGE YIELA EARNED
INTEREST EARNED DURING CYCL.E:PERIOD 399
CURRENT INTEREST RATE p.9,gy
AV °D'AsE QA'..^ -."'C° C^P T''�� ST1ST�l °ErL'rnvr`c
$q 263 18
m sa .ANK.
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.
J Tl ,L2 Terms
s��,• haP� //t/ Date Due
Invoice Invoice Description Amount
Q Date Number (or note attached invoice(s) or bill(s))
///D/
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 NO. WARRANT NO.
,L ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
y�z Z �sc�
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
a �f35'7600 ,2eg. 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
02 20o
Sig ure
tne e%
Cost distribution ledger classification if le
claim paid motor vehicle highway fund