HomeMy WebLinkAbout207518 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 362657 Page 1 of 1
ONE CIVIC SQUARE KOMEN INDPLS RACE FOR THE CURE
CARMEL, INDIANA 46032 1099 N MERIDIAN STREET SUITE 111 CHECK AMOUNT: $100.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 207518
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355100 100.00 DONATION
Central Indiana Affiliate Susan G. Komen for the Cure: Page 1 of 1
Participant Race Fundraising Center
Gift Information
Thank you for your gift to 2012 Komen Central Indiana Race For the Cure on behalf of Faithful Friends.
Gift Information
Select A Gift Amount: $21.00 21st ANNIVERSARY GIFT. To celebrate the 21 years since the Komen Central Indiana Race was
founded your support is what makes this one of the top 10 largest Races in the world!
$37.00 HOOSIER WOMEN GIFT. To help increase the rate of women in Central Indiana who getting their
annual mammograms on average, 37% are not getting screened regularly.
$74.00 IMPACT GIFT. To recognize that a woman dies of breast cancer every 74 seconds. In the past it
was 69 seconds help make it no seconds.
100.00 SURVIVAL GIFT. To help cover the cost of screening services, like a mammogram for a woman in
need.
$250.00 MEDICAL ASSISTANCE GIFT. To help cover the cost of diagnostic and treatment assistance
services, including MRIs and biopsies.
$500.00 HEALTHCARE HERO GIFT. A gift of $500 or more will help cover the cost of multiple services for
women throughout their continuum of care.
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2010 Central Indiana Affiliate, Susan G. Komen for the Cure. All Rights Reserved.
Phone: (317) 638 -CURE (2873) Email: info @komenindy.org
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
4 u— Payee 1� Wnt Purchase Order No.
IJ
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
07/*- n' l P 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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund