219077 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366267 Page 1 of 1
ONE CIVIC SQUARE ASHLEY ULBRICHT CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 433 AUTUMN DRIVE
CARMEL IN 46032 CHECK NUMBER: 219077
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 26421 03 . 27 . 13 100 . 00 WELLNESS PROGRAM
CITY OF CARMEL WELLNESS PROGRAM
.� PRIZE/REWARD STATEMENT
Al
Date: March 27, 2013
Name of Prize/Reward: First Quarter Weight Loss Challenge
First Place - Female
Amount: $ 100.00
Line Item: 419-80
Check Made Out To: Ashley Ulbricht
Please Return Check to Sue Wolfgang in Human
Resources
o �aa
APR 0 b 2013 ,
By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Ulbricht, Ashley
IN SUM OF $
Employee
$100.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26421 I 03.27.13 I 43-419.80 I $100.00 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, April 03, 2013
Director, HR
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))
03/27/13 03.27.13 1 st Qtr Weight Loss Challenge $100.00
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer