210181 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00351485 Page 1 of 1
0 ONE CIVIC SQUARE BECKY LANNAN CHECK AMOUNT: $12,000.00
CARMEL, INDIANA 46032 2820 BRIDLEWOOD CIRCLE
CARMEL IN 46033 CHECK NUMBER: 210181
CHECK DATE: 6120/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
802 4126500 12,000.00 RETIREMENT -DEATH BENE
CITY OF CARMEL
(Name of Governmental Unit)
FIRE Pension Fund
To Disbursing Officer:
The following is a schedule of Pension and Disability payments due members, or their dependents, for which it is requested
individual warrants be issued, payable from the above named fund.
Payments due June 2012
WARRANT NAME GROSS TAX AMOUNT OF
NUMBER PAYMENT WITHHELD WARRANT
1 Death Benefit for Terry Fleming $12,000 $12,000
Paid to Becky Lannan
CERTIFICATE
I hereby certify that the foregoing amounts are just and co t o of s has been paid.
r ry, Pension Fund
Claim No. Warrant No.
In Favor Of
Pensioners Scheduled Herein
Gross Payments: $12,000
Tax /Ins. Withheld: 0
Amount of Warrants: $12,000
On Account of Appropriation
For FIRE PENSION BOARD
I have examined the within claim and
hereby certify that same is in proper form and correct
and I hereby authorize payment of same.
Secretary FIRE Pension Fund
Approved for Payment b
I and o ee
I
President of the Bo
A.F. NOYCE CO., MUNCIE, IND. 99