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207171 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 366088 Page 1 of 1 ONE CIVIC SQUARE WANDA MORAN CARMEL, INDIANA 46032 18910 NORTHBROOK CIRCLE CHECK AMOUNT: $50.00 WESTFIELD IN 46074 CHECK NUMBER: 207171 CHECK DATE: 3113/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 R4341980 21668 03.12.12 50.00 WELLNESS PROGRAM CITY OF CARMEL WELLNESS PROGRAM PRIZE /REWARD STATEMENT Date: March 12, 2012 Name of Prize /Reward: First Quarter Weight Loss Challenge Second Place Female Amount: 50.00 Line Item: 419 -80 D G MAR 12 2012 Check Made Out To: Wanda Moran By Please Return Check to Sue Coy in Human Resources VOUCHER NO. WARRANT NO. ALLOWED 20 Moran, Wanda IN SUM OF Employee $50.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members hereby certify that the attached invoice(s), or 21668 03.12.12 43- 419.80 $50.00 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 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 $50,00 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