208449 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366186 Page 1 of 1
ONE CIVIC SQUARE LOIS RUNDLE
CARMEL, INDIANA 46032 12120 WINDSOR DRIVE CHECK AMOUNT: $1,425.00
CARMEL IN 46033 CHECK NUMBER: 208449
ON
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1,425.00 MEMBERSHIP REFUND
St.Vincent
Hospice
84>0 North Pncm- Rnad
>uitc 100
Indianai,di IN 46268
317) 3 38 -4040
s") 780 -7284 April 10, 2012
stc{nccnt.o, n
To Whom It May Concern:
Norman Rundle is currently a patient with St. Vincent
Hospice in the homecare setting. His wife, Lois, is
acting as his primary caregiver. It had been hoped
that Lois would be able to leave the home at times in
order to play golf this spring and summer. However,
upon trying to work out the details, it has become
obvious that this is not advisable. Mr. Rundle is in
need of constant attention and care. Therefore, it does
not seem realistic that his wife will be able to have the
A member of available time to utilize her golf membership.
,&,SCENSION
M H E A L T H
Core Values
Ite are called to: Thank you for your understanding.
Service of the Poor
Gcnerosin of spirit for
r
persons most in need.
Reverence Carol Berto Stout, ACSW; LCSW; LMFT
Respect and compassion
for the dignity and diversity Clinical Social Worker
of life.
Integrity St. Vincent Hospice
Inspiring trust through
personal leadership.
Wisdom
Integrating excellence
and stewardship.
Creativitv
Courageous innovation.
Dedication
Affirming the hope and
joy of our ministry.
A member of StYbice11t
li65l 1206
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))
04/10/12 RUNDLE Refund Membership $1,425.00
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
VOUCHER NO. WA R RA NT N
ALLOWED 20
Lois Rundle
IN SUM OF
12120 Windsor Drive
Carmel, IN 46033
$1,425.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 I RUNDLE 3 1 5- I 1,2a 5 1 hereby certify that the attached invoice(s), or
'.S DaS 4 bill(s) is (are) true and correct and that the
6, materials or services itemized thereon for
2Ae D 160, 6 9
which charge is made were ordered and
received except
Friday, April 13, 2012
L &Z, 2 d (�v
Director, BrooVshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund