210837 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 366410 Page 1 of 1
ONE CIVIC SQUARE GREG FERRIN
CARMEL, INDIANA 46032 3 WILSON DRIVE CHECK AMOUNT: $481.04
ti r ? CARMEL IN 46032 CHECK NUMBER: 210837
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 481 . 04 OTHER EXPENSES
v �•
CITY O= '
ARMEL
JAMES BRAINARD, MAYOR
.July 16, 2012
Mr. Greg Ferrin
3 Wilson Drive
Carmel, IN 46032
RE: INVOICE #201201333 DOS 04/25/2012
Dear Mr-Ferrin:
Enclosed you will find a reimbursement check in the amount of$481.04.
On May 22, 2012 we received a check from you in the amount of$481.04 for your
ambulance transport on April 25, 2012. We filed a claim for your ambulance run and
your Medicare and supplement insurance paid the invoice. If you have any questions,
please feel free to contact me at (317) 571-2604.
Sincerely,
Michelle T. Harrington
Billing Administrator
CARMEL FmF. DFRARTMENT
STEVEN A. Cou-i's HEADQU,ARTFRS
Two CIVIC SQUARE, CARtMEi., IN 46032 01-FICI? 3.17-571..2600, FrN 317.57:1..2615
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.
Payee
Purchase Order No.
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
Board Members
PO#or DEPT# INVOICE NO. ACCT#!TITLE AMOUNT 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
JUL 16 2012
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund