221499 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 00352832 Page 1 of 1
ONE CIVIC SQUARE FIFTH THIRD BANK
CARMEL, INDIANA 46032 ACCT#XXXX-XXXX-XXXX-2798 CHECK AMOUNT: $741.60
PO BOX 740523
CHECK NUMBER: 221499
CINCINNATI OH 45274-0523
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 2798 69. 00 MEDICAL FEES
1091 4341991 2798 395 . 00 MARKETING & PROMOTION
1094 4358300 2798 250 . 00 OTHER FEES & LICENSES
1125 4342100 2798 27 . 60 POSTAGE
I
Fifth Third Bank
FIFTH THIRD BANK ACCOUNT NUMBERXXXX XXXX XXXX 2798
PO BOX 740523 PAYMENT DUE DATE 07-23-13
CINCINNATI OH 45274-0523
AMOUNT DUE $947.20
CURRENT BALANCE $947.20
FIFTH THIRD BANK
PO BOX 740523
CINCINNATI OH 45274-0523 AMOUNT
ENCLOSED $ ` too
CARMEL CLAY PARKS & RECR —T0004952 -,-
CORPORATE BILLING ACCT tf t
14011AED116THOSTRZEWA JUL
213
CARMEL IN 46032-3455
I� F-
5569260004422798 0000947200 000094'7200-------- _�
Please tear payment coupon at perforation.
°°_°°°°--------------------------°-----°—_------------------------°----°-----_—___------_—____°
:STATEMENT' E
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CORPORATE`ACCOUNeT��SUMMARY
CORPORATE ACCOUNT NUMBER
XXXXXXXXXXXX2798
CLOSING DATE 06-28-13 PREVIOUS BALANCE 1,274.93
PAYMENT DUE DATE 07-23-13 PURCHASES AND OTHER CHARGES 947.20
CREDIT LIMIT 40,000 CASH ADVANCES .00
AVAILABLE CREDIT 39,053 CREDITS .00
PAYMENTS 1,274.93-
FOR CUSTOMER SERVICE CALL: LATE PAYMENT CHARGES .00
1-800-375-1747
CASH ADVANCE FEE .00
SEND BILLING INQUIRIES TO: FINANCE CHARGES .00
FIFTH THIRD BANK NEW BALANCE 947.20
P.O.BOX 630781
CINCINNATI OH 45263-0781 TOTAL PAYMENT DUE 947.20
DISPUTED AMOUNT .00
Page 1 of 2
ACCT. NUMBER: )0=X)0(X)0= 2798
CREDIT LIMIT 40,000.00 CASH ADVANCE BALANCE .00
CURRENT BALANCE 947.20 MINIMUM PAYMENT DUE 947.20
AVAILABLE CREDIT 39,052.80 PAYMENT DUE DATE 07-23-13
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IRA
CARMEL CLAY PARKS 8 RECREATION TOTAL CORPORATE ACTIVITY
XXXX-XXXX-XXXX-2798 $1,124.93 CR
Post Trans
Date Date Reference Number Transaction Description Amount
06-24 06-24 75569263175000000000016 PAYMENT RECEIVED-THANK YOU 1,274.93 PY
06-25 06-24 75569263176000000027430 ANNUAL MGMT FEE 150.00
'IN VIDUAL e ARDH
OLPERA CTIV Ty'
x
DAWN R KOEPPER CREDITS PURCHASES CASH ADV TOTAL ACTIVITY
XXYX-XXXX-XXXX-2814 $0.00 $700.60 $0.00 $700.60
Post Trans
Date Date Reference Number Transaction Description VCN Amount
06-12 06-11 55310203163286879500095 CISION US INC 03129222400 IL 395.00
06-19 06-17 85180893169980159882860 SMARTWAIVER 541516-0174 OR 250.00
06-27 06-26 55432863177000775722382 AMAZON.COM AMZN.COMIBILL WA 55.60
PAULA SCHLEMMER CREDITS PURCHASES CASH ADV TOTALACTIVITY
XXXX-XXXX-XXXX-9873 $0.00 $27.60 $0.00 $27.60
Post Trans
Date Date Reference Number Transaction Description VCN Amount
06-19 06-18 05410193169418187176521 USPS 17127608130911713 CARMEL IN 27.60
MICHAEL W KLITZING CREDITS PURCHASES CASH ADV TOTAL ACTIVITY
XXXX-XXXX-XXXX-2421 $0.00 $69.00 $0.00 $69.00
Post Trans
Date Date Reference Number Transaction Description VCN Amount
06-06 06-05 55310203157200069600118 ABOUT MY HEALTH SAINT LOUIS MO 69.00
Page 2 of 2
Dawn Koepper
From: noreply @salesforce.com on behalf of Cision US [amanda.rueda @cision.com]
Sent: Tuesday, June 11, 2013 12:57 PM
To: Dawn Koepper
Subject: Cision Payment Processed
Dear Dawn Koepper,
Thank you. Your payment has been successfully processed. Below you will find the details of your payment.
Amount : $ 395.00
Payment Date : 06/11/2013 - VF I
Credit Card : XXXX-XXXX-XXXX-2814 11 JUN 1 1 2013 '
Reference : Payment for fNV-0000002515 LYE
Report-Ad-Hoc-TV-Nielsen(TV)
Total $395.00
Paid Amount $395.00
Balance Due $0.00
Sincerely,
Cision
1 Market St
San Francisco, CA 94105
US
Please do not reply to this message. This email is not regularly monitored.
i
Smartwaiver Invoice #34749616 Page 1 of 1
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v, 5,: I„$
@� 0 233 SW Wilson Ave., Suite 1
I M — Bend, OR 97702
Phone: 800-277-0265
Email: cs @smartwaiver.com
Invoice #: 34749616
Invoice Date: 06/17/2013
Usemame: monon
Service Plan: Smartwaiver Service Plan
Description Price USD
Smartwaiver Service Plan $250.00
Payment Received 06/17/2013 (Card: XXXX-XXXX-XXXX-2814) - Thank you! $250.00
Ending Balance USD: $0.00
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https://www.smartwaiver.com/m/chargify_parent/sw chargify_main.php?sw_chargemain_... 6/17/2013
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Customer Copy
, a
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ABOUT MY HEALTH Invoice
2737 Sutton Ave
Saint Louis. MO 63143 Date Invoice#
866-926-4669 6/10(2013 1317
info@aboutrnyhealth.us
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Bill To
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Attn:Lynn Russell DV-UQ
Phone:317-573-4019
Email:]rLISSell6iearineleliypirks.cc)in 1 b c) -r
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JUN 112013
Item Quantity Description Rate Serviced Amount
i Panel Urine Drug Test I Amphetamines
69.00 0/0/2013 69.00
Cocaine
Marijuana
Opiates
Phencyclidine
This collection is for:
-Katherine Page
Paid in full Paid in full
-100.00% 6/5/2013 -69.00
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This has been paid in full.Thank you for your business.
Total $0.00
Fifth Third Vendor Fund 101 ''f'IFund 109
Other
Marketing fees & Medical
_ Postage I & Promos licenses l Fees
—� 1125 1091 1094 1091
V# 354296 I 4342100, $4395 341991I 4358300,4340700 I-- —
06/11113 Cision US _
06 / 33 AboutMy Health _ $ 69.00
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06/17/13 SmartWaiver $ 250.00
06/18/13 Carmel P.O. f $ 27.60 �_ --
$ 27.6. 0 $ 395.00 $ 250.00 $ 69.00 $ 741.60
---- —I Fund 101 1i__'Fund 109
��-- Other
- —
Marketing fees & Medical
Postage_ &_Promos licenses Fees
1125 1091 1094 1091
j I� 4342100, 43419911 435830014340700
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
00352832 Fifth Third Bank
P.O. Box 740523
Cincinnati, OH 45274-0523
Invoice Invoice Description Amount
or note attached invoice(s) or bill(s)) PO#
Date Number ( $ 27.60
6/28/13 2798 Postage $ 395.00
6/28/13 2798 Marketing $ 250.00
6/28/13 2798 Other fees & licenses 69.00
6/28/13 2798 Medical fees
Total $ 741.60
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
Voucher No. Warrant No.
00352832 Fifth Third Bank Allowed 20
P.O. Box 740523
Cincinnati, OH 45274-0523
In Sum of$
$ 741.60
ON ACCOUNT OF APPROPRIATION FOR
101 General / 109 Monon Center
PO#or Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
Dept#
1125 2798 4342100 $ 27.60 1 hereby certify that the attached invoice(s), or
1091 2798 4341991 $ 395.00 bill(s) is(are)true and correct and that the
1094 2798 4358300 $ 250.00 materials or services itemized thereon for
1091 2798 4340700 $ 69.00 which charge is made were ordered and
received except
1-Jul 2013
Signature
$ 741.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund