HomeMy WebLinkAbout217070 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00351349 Page 1 of 1
? ONE CIVIC SQUARE DOUG CALLAHAN
CARMEL, INDIANA 46032 C/O CARMEL FIRE DEPT CHECK AMOUNT: $300.00
C/O CARMEL FIRE DEPT CHECK NUMBER: 217070
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CHECK DATE: 2/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 020513 300 . 00 OTHER EXPENSES
City of Carmel Employee Health Benefit Plan
Health Savings Account Incentive
The retired plan participant listed below has elected Plan A for 2013 and is eligible for a bi-
annual contribution to his or her HSA account, as authorized by Resolution BPW-10-03-12-02.
Please return check to Human Resources for further processing.
Plan Participant/Payee:
Doug Callahan
1015 East 106th Street
Indianapolis, IN 46280
Amount: $300.00
Fund: Medical Escrow Fund (301)
Date: February 5, 2013
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
Doug Callahan Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total $300.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Doug C211ah-an IN SUM OF $
1015 East 106th StrePt
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ON ACCOUNT OF APPROPRIATION FOR �t
301 Meck-21 R ind
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund