HomeMy WebLinkAbout222937 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367456 Page 1 of 1
ONE CIVIC SQUARE EARL FYFFE
CARMEL, INDIANA 46032 CHECK AMOUNT: $394.63
3724 HOLLY ST
GROVE CITY OH 43123 CHECK NUMBER: 222937
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 5023990 394 . 63 OTHER EXPENSES
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CITY O EL
J,NmES BRAINARD, NLAYOR
August 9, 2013
Earl Fyffe
3724 Holly Street
Grove City, OH 43123
RE: Ticket# 20125220:1 D.O.S. 11/15/2012 Earl Fyffe
Dear Earl Fyffe:
Enclosed you will find a reimbursement check in the amount of$ 394.63.
On January 15, 2013 we received your payment for $ 394.63.
CareWorks paid $ 394.63 on July 29, 2013 for your worker's compensation
claim.
The overpayment is your refund for $ 394.63.
If you have any questions, please feel free to contact me at (3)17) 571-2604.
Sincerely,
Michelle T. Harrington
Billing Administrator
CARAIEL FIRE DEPARTNIENT
STEVEN A. COUTs HEADQUARTERS
Two CIVIC SQUARE, CAR IEL, IN 46032 OEEIcE 317.571.2600, FAx 317.571.2615
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A/R Detail
Type Transaction Adjudication Entered Amount Reference Memo Status
Date Date Date Number
Invoice 11/15/12 11/15/12 11/14/12 $394.63 Posted
Payment 01/15/13 01/15/13 01/14/13 ($394.63) CC EARL FYFFE CC 970(Posted
Payment 07130/13 07/30/13 07/30/13 ($394.63) 5776533 Posted
Credit 08/09/13 08/09/13 08/09/13 $394.63 REFUND PATIENT WORKERS CCOMP CPosted
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
boa 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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund