218078 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 365200 Page 1 of 1
ONE CIVIC SQUARE HEALTH PORT
CHECK AMOUNT: $209.23
CARMEL, INDIANA 46032 PO BOX 409822
`y-r ATLANTA GA 30384-9822
>o„ CHECK NUMBER: 218078
CHECK DATE: 311 312 01 3
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4358200 123019447 209. 23 SPECIAL INVESTIGATION
I
HealthPort ®® Invoice #: 0123019447
P.O. Box 409822 ®o HealthPort.. Date: 2/22/2013
Atlanta, GA 30384-9822 INVOICE Customer #: 134332
Fed Tax ID 58 - 2659941
(770) 754 - 6000
Ship to: Bill to: Records from:
DETECTIVE HARLAND J MCNZIR DETECTIVE HARLAND J MCNZIR IU HEALTH METHODIST HOSPITAL
PROSC ATTY OF HAMILTON COUNTY PROSC ATTY OF HAMILTON COUNTY 1701 SENATE AVENUE
3 CIVI SQUARE 3 CIVI SQUARE INDIANAPOLIS, IN 46206
CARMEL, IN 46032 CARMEL, IN 46032
Requested By: PROSC ATTY OF HAMILTON COUNTY DOB: 081060
Patient Name: LAMBICURE CATHERINE
Description Quantity Unit Price Amount
Basic Fee 20.00
Retrieval Fee 0.00
Per Page Copy (Paper) 1 628 0.25 157.00
Per Page Copy (Paper) 2 40 0.50 20.00
Per Page Copy (Paper) 3 10 0.00 0.00
Shipping 12.23
Subtotal 209.23
Sales Tax 0.00
Invoice Total 209.23
Balance Due 209.23
I
Pay your invoice online at www.HealthPortPay.com
Terms: Net 30 days Please remit this amount : $ 209.23 (USD)
VOUCHER NO. WARRANT NO.
HealthPort ALLOWED 20
IN SUM OF $
P.O. Box 409822
Atlanta, GA 30384-9822
$209.23
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT _ Board Members
1110 I 123019447 I 43-582.00 I $209.23 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, March 06, 2013
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))
02/22/13 123019447 investigation fees $209.23
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