HomeMy WebLinkAbout213178 09/25/2012 a- CITY OF CARMEL, INDIANA VENDOR: 365641 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $236.00
CARMEL, INDIANA 46032 HEALTH INFORMATION MANAGEMENT
oat;? 2001 W 86TH STREET CHECK NUMBER: 213178
INDIANAPOLIS IN 46260
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 50130 236 . 00 SPECIAL INVESTIGATION
St. Vincent Hospital Invoice No
Health Information Management 50130
2001 W. 86th Street
Indianapolis, IN 46260
( 317 ) 338-2216 Tax ID:35-0869066
Date: 01/03/2012
i
To: Carmel Police Department C6C
3 Civic Square
Carmel, IN 46032
Attn: Sgt Nancy Zellers
* * * Duplicate Invoice * * * 238 Days Over Due
Patient: Larry ll Brown
Request No Invoice No Medical Record No Date Received Date Sent
B116571 50130 2186394 01/03/2012 01/03/2012 Pages/Time Charges
Photocopy 834 236.00
If this bill has been paid, please send a copy
of the front and back of your cancelled check.
Sales Tax 0.00
Total Billed $236.00
Amount Paid 0.00
Balance $236.00
To ensure proper posting of payments, please send Attn: Health Information Services Department
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Hospital
Health Information Management IN SUM OF $
2001 W. 86th Street
Indianapolis, IN 46260
$236.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1110 I 50130 I 43-582.00 I $236.00 1 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
Wednesday, September 19, 2012
Chief of Police
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))
01/03/12 50130 case#12-65048 $236.00
1 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