HomeMy WebLinkAbout216792 01/29/2013 \.� CITY OF CARMEL, INDIANA VENDOR: 362130 Page 1 of 1
0 ONE CIVIC SQUARE MICHAEL LUPER II
CARMEL, INDIANA 46032 11130 ECHO CREST DR EAST CHECK AMOUNT: $79.00
INDIANAPOLIS IN 46280 CHECK NUMBER: 216792
CHECK DATE: 1129/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 79 . 00 CLD LICENSE
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RECEIPT
Community Employer Health Solutions Carmel
11911 N.Meridian St.,Ste.160
Carmel, IN 46032
(317)621-6704
Account Name: Self Pay Date: 01/15/2013
Received from: Self Pay Payment Type:
For: Physical Examination C_nL_ Amount: $79.00
Reference#:
Description: Received by: Yf�
Payor Copy
RECEIPT _
Community Employer Health Solutions Carmel
11911 N.Meridian St., Ste.160
Carmel, IN 46032
(317)621-6704
Account Name: Self Pay Date: 01/15/2013
Received from: Self Pay Payment Type:
For: Physical Examination Amount: $79.00
Reference#:
Description: Received b
Patient Birth Date: 02/03/1980 Invoice#:
Clinic Copy
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Contact Us Seance Center Help PTtV2Cy 6 Security FAG'S
Account Activity
Welcome,MICHAEL E LUPER II
Tuesday,January 15,2013
Account Activity I Account Summary I Account Statements& Documents Export History
X7326
Balance as of 01/14/13;
Pending Transactions (5/3 ESSENTIAL CHECKING X7328) LHide
Date TIME Deb,t(-) Cred.t(+ Descript,on Action
01/15/13 09:55 AM $79.00 PRE-AUTHORIZATION DEBIT AT OCCUPATIONAL HEALTH CA,INDIANAPOLIS,IN
ON 011513 FROM CARD, XXXXXXXXXXXX8905
Posted Transactions ( Ltgel
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Date Debi u- Credit(+) Check Description Balance Action
01/14/13 ...DAILY BALANCE... $
01/14/13
VOUCHER # 123340 WARRANT # ALLOWED
T2292 IN SUM OF $
LUPER, MIKE
UTILITIES/DC
l(
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
i
i
PO # INV# ACCT# AMOUNT Audit Trail Code
i
000006 01-6040-05 $79.00
l
1
Voucher Total $79.00
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T2292
LUPER, MIKE Purchase Order No.
UTILITIES/DC Terms
Due Date 1/22/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/22/2013 000006 $79.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC1 5-11-10-1.6
Date Officer