224292 09/23/2013 CITY OF CARMEL, INDIANA VENDOR: 00350364 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY MEDICAL SERVICES
CARMEL, INDIANA 46032 324 E NEW YORK ST SUITE 300 CHECK AMOUNT: $84.91
INDIANAPOLIS IN 46204
„o„ o CHECK NUMBER: 224292
CHECK DATE: 9/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4340700 21199 84 . 91 MEDICAL FEES
INVOICE
o Public Safety Medical Services
...' 324 E. New York Street
E Suite 300
w Indianapolis, IN 46204
0 Carmel Clay Parks & Recreation/CARMELPARK
H Attn: Jeff Kramer Terms
1411 E. 116th Street Invoice Date 09/05/2013
m
Carmel, IN 46032 Invoice# 00-21199
Date Employee Description Amount Balance.Due
08/28/13 Wright, Paula A. Hepatitis B Vacc#1 $74.29 $74.29
Injection Fee $10.62 $10.62
Total Charges-?: $84.91
Total Payments&Balance Due-> $0:00! $84:91
Please write invoice number on payment check.
Balance due 15 days from invoice
Our Federal Employer Identification Number is 35-2079797 date
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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.
00350364 Public Safety Medical Services Terms
324 E. New York Street, Ste 300
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
9/5/13 21199 Medical fees $ 84.91
Total $ 84.91
I hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and 1 have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
Voucher No. Warrant No.
00350364 Public Safety Medical Services Allowed 20
324 E. New York Street, Ste 300
Indianapolis, IN 46204
In Sum of$
$ 84.91
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO#or Board Members
INVOICE NO. ACCT#/TITL AMOUNT
Dept#
1091 21199 4340700 $ 84.91 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
19-Sep 2013
Signature
$ 84.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund