207159 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 00350692 Page T of 1
ONE CIVIC SQUARE RANDY MASSINGILL
CARMEL, INDIANA 46032 130 1ST AVE SW CHECK AMOUNT: $150.00
CARMEL IN 46032
CHECK NUMBER: 207159
CHECK DATE: 3/1 312 01 2
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 21668 03.12.12 150.00 WELLNESS PROGRAM
CITY OF CARMEL WELLNESS PROGRAM
PRIZE /REWARD STATEMENT
Date: March 12, 2012
Name of Prize /Reward: First Quarter Weight Loss Challenge
First Place Male
Amount: 150.00
El
Line Item: 419 -80
Check Made Out To: Randy Massingill
Please Return Check to Sue Cov in Human Resources
VOUCHER NO. WARRANT NO.
ALLOWED 20
Massingill, Randy
IN SUM OF
Employee
$150.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
21668 03.12.12 43- 419.80 $150.00 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
Monday, March 12, 2012
r
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Date Number (or note attached invoice(s) or bill(s))
03/12/12 03.12.12 1st Qtr Weight Loss Challenge $150.00
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