HomeMy WebLinkAbout216127 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 362134 Page 1 of 1
ONE CIVIC SQUARE TRENT MORGAN
CARMEL, INDIANA 46032 9250 W CR 400 N CHECK AMOUNT: $55.00
MULBERRY IN 46058 CHECK NUMBER: 216127
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 55 . 00 REIMBURSEMENT
Indiana University Health Arnett
PO BOX 5545
LAFAYETTE, IN 47903-5545
765-448-8000
Receipt Date: Fri 12/21/12 4 : 10 PM
Account. Name:.-_- Patient Name: MORGPN,TRENT M
Account ID #: Patient ID #: 2024456
Co-pay Received: $55 . 00 Source: CASH Ref : 60-5=55
Payment Received: 0 . 00 Source : Ref :
_ _Received By: 1687
Please keep this receipt for your records
Patient Copy
VOUCHER # 123128 WARRANT # ALLOWED
TTRENT IN SUM OF $
TRENT MORGAN
WATER DISTRIBUTION OFFICE
t
r
1.
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR 1
4
I Board members
a
PO# INV# ACCT# AMOUNT Audit Trail Code
1
2024456 01-6040-05 $55.00
I
1
Voucher Total $55.00
Cost distribution ledger classification if
claim paid under vehicle•highway fund
i
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
TTRENT
TRENT MORGAN Purchase Order No.
WATER DISTRIBUTION OFFICE Terms
Due Date 12/29/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/201: 2024456 $55.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
,orrect and I have audited same in accordance with IC 55-11-10-1.6
Date Officer