HomeMy WebLinkAbout213507 10/10/2012 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE INDIANA ORAL&MAXILLOFACIAL
CARMEL, INDIANA 46032 SURGERY ASSOCIATES CHECK AMOUNT: $21.15
9240 N MERIDIAN ST SUITE 300 CHECK NUMBER: 213507
INDIANAPOLIS,IN 46260
CHECK DATE: 10110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 21 . 15SPECIAL INVESTIGATIO
INDIANA DENTAL IMPLANTS URGERY
RTHOGNATHIC SURGERY
ORAL & MAXILLOFACIAL OREPROSTHE IC AND RECONSTRUCTIVE SURGERY
F c � n Dec SUR YT DISORDERS ASSOCIATES lncos
DIPLOMATES,AMERICAN BOARD OF
ORAL AND MAXILLOFACIAL SURGERY
Thomas H.Lapp,D.D.S.,M.S.
David A.Bussard,D.D.S.,M.S.
Joseph E Heidelman,D.D.S.
Jeffrey D.Buttrum,D.D.S.
John E.Moenning,D.D.S.,M.S.D. IOMSA
J.Jeffrey Hockema,D.D.S. q
Philip M.Montefalco,D.D.S. Date: -I'Z5 I 924o N. Meridian St.
Michael G.Kapp,D.D.S. o0
l
Sute
John W.Pruitt,D.D.S.,M.D. 1^ 3
John W.Adelsperger,D.D.S. Patient Name: �Zl�Y I FDdf r Indianapolis, IN 4626o
Tyler J.Potter,D.D.S.
Christopher Kirkup,D.D.S.,M.S. 317-846-7377
Matthew.T ncredi,D.D.S.,M.S. Account # �'-� � ZD3 317-846-8566 (fax)
Samuel A.Tancredi,D.D.S.
Retired
R.D.Lentz,D.D.S.
Dan E.Faulk,D.D.S. 1956-2010 To Whom It May Concern:
Brownsburg It is the policy of Indiana Oral and Maxillofacial Surgery
317-297-1007 Associates to charge a fee for chart copies in accordance with
Castleton state laws. The charges are as follows:
317-849-4914
East Washington
317-899-5000 Chart Records Fee Each Quantity Amount Due
Fishers
317-845-7878 Labor $15.00 $15.00
Franklin
317-882-3370
Over 10 pages $ .25/each 1_1 q-25
Greenwood
317-882-3370 _
Certifications $10.00
North Keystone
317-846-3446
X-rays $5.00
North Meridian
317-846-7377 I q O
Southport Postage
317-882-1284
West �} I
317-297-1007 Total Amo>L:r'<t Due
Zionsville
317-733-0926
In order for us to forward the requested information, please
remit the total amount due in full. If you have any questions,
please do not hesitate to contact our office.
Thank You,
For more information
please UISIt:
��I IOMSA.COM
�uia
Necia Aynes
Administrative Office: Record Custodian
8140 Knue Road,Suite 103
Indianapolis,IN 46250
317-913-2363
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Oral & Maxillofacial Surgery Associates
IN SUM OF $
9240 N. Meridian Street, Suite 300
Indianapolis, IN 46260
$21.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 43-582.00 $21.15
I hereby certify that the attached invoice(s), or
I I
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
Tuesday, October 02, 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))
09/25/12 12-48042 $21.15
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