242731 03/03/2015 CITY OF CARMEL, INDIANA VENDOR: 099475 Page 1 of 1
ONE CIVIC SQUARE FRED PRYOR SEMINARS
CARMEL, INDIANA 46032 PO BOX 219468 CHECK AMOUNT: $179.00
KANSAS CITY,MO 64121-9468 CHECK NUMBER: 242731
TaN
CHECK DATE: 3/3/2015
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4357004 17089836 179. 00
II
i
FRED PRYOR SED WM rS �CAREEE�TRACKID
divisions of PARK University Enterprises,Inc.
2/25/15
Dear ERIC,
Thank you for enrolling for OSHA COMPLIANCE. We appreciate your business
and are excited you have chosen us as your business skills training
provider.
**Payment is due before you may attend the seminar.** If you would like
to pay by credit card, please call 800-556-3012. Please mail checks or
?rocess ACH payments no less than 7 business days prior to the seminar
o allow for processing time.
Please review the seminar and attendee information listed below and contact
us toll-free at 800-556-3012 if you have any questions. If you are unable to
attend, ou may send a substitute from your organization or transfer your
registration to another seminar.
Thank you again for choosing us as your training provider. Enjoy your seminar!
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Get the most from your seminar... 1 Day Seminar
SEE REVERSE SIDE FOR DETAILSI Program:
OZ/OSHA COMPLIANCE
Seminar Date: Friday April 17, 2015
Check-in: BEGINS AT 8:3 0 AM
Seminar Time: 9:0 0 AM 4:0 0 PM
MR ERIC RUSSELL Seminar flotation:
THE CITY OF CARMEL STREET DEPA Hampton Inn Downtown
105 S. Meridian St.
Indianapolis, IN 46225
317-261-1200
ATTENDEE: MR ERIC RUSSELL
-------------------------------------------------------------r-------------------------------------------------------------
THIS IS YOUR ORIGINAL INVOICE REMITTANCE STUB
(Forward to Your Accounts Payable Dept.) (Payment is due upon receipt of this invoice. Please return
Attendee Name:MR ERIC RUSSELL this remittance stub with your payment.)
Customer#: 32889847 Order#:1-007874161 ;
Your PO#: Federal ID#:43-1830400 Invoice#: 17089836 Tuition: 179.00
Invoice Date: 02/25/2015 Invoice#: 17089836 t Customer#: 32889847 Tax: .00
i
Event#:166 743 Amount Paid: .00
Program: OZ/OSHA COMPLIANCE 290038 04/17/2015 Total Amount Due: 179.00
Seminar Date: Friday April 17, 2015 Method of Payment:❑Check# Please submit
Seminar location:Hampton Inn Downtown
105 S. Meridian St. ; TnPient tto:
Indianapolis, IN 46225 ; ❑Visa 11 MC FA Pryor
❑AMEX ❑Discover Seminars
Payment is due upon receipt of this invoice. Ex'.Dale
� PO Box 219468
i Kansas City,MO 64121.9468
Tuition: 179.00 Amount Paid: .00 Card rF
Tax: , •0 0 Total Amount Du—e: 179.00
'
,tC REE I tV SCK. Cardholder Signature
PRXIXt� R<ax Exempt#:
divisions of PARK University Enterprises,Inc. (Please attach a copy of your Tax Exempt Certificate for payment processing if applicable.{
t
01/07 i
Form ST-105 Indiana Department of Revenue
State Form 49065 RV 8-05 General Sales Tax Exemption Certificate
Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana
code. Exemption statutes of other states are not valid for purchases from Indiana vendors.This exemption certificate can not be issued for the
purchase of Utilities, Vehicles Watercra ,or Aircraft, Purchaser must be registered with the Department of Revenue or the appropriate taxing
authority of the purchaser's state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide all required
information must pay the tax and may file a claim for refund(Form GA-110L)directly with the Department of Revenue.
`Name of Purchaser CITY OF CARMEL
Business Address ONE CIVIC SQUARE City CARMEL State IN Zip 46032
Purchaser must provide minimum of one ID number below.*
A+
Provide your Indiana Registered Retail Merchant's Certificate
TID and LOC Number as shown on your Certificate........ 0031201550 — 020
.......................
i+ TID#(10 digits) LOC#(3 digits)
iW
t If not registered with the Indiana DOR,provide your State Tax
ID Number from another State................................................................
'See instructions on the reverse side if you do not have either number. State ID# State of Issue
Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one)
Description of items to be purchased.
t
Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain)
❑ Sales to a retailer,wholesaler,or manufacturer for resale only,
❑ Sale of manufacturing machinery,tools,and equipment to be used directly in direct production.
❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10.
(May not be used for personal hotel rooms and meals.)
❑ Sales of tangible personal property predominately used(greater then 50 percent)in providing public transportation-provide USDOT#.
A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a school bus operator,must
provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT#
❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale.
Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a State ID#in Section#1.
k. :.
❑ Sales to a contractor for exempt projects(such as public schools,government,or nonprofits). -
❑ Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and state universities).
❑ Sales to the United States Federal Government-show agency name.
Note:A U.S.Government agency should enter its Federal Identification Number(FID#)in Section#1 in lieu of a State ID#.
❑ Other-explain.
I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt
purpose pursuant to the State Gross Retail Sales Tax Act,Indiana Code 6-2.5,and the item purchased is not a utility,vehicle,watercraft,or aircraft.
I confirm my understanding that misuse- either negligent or' entional),and/or fraudulent use of this certificate may subject both me personally
. and/or the business entity I represen, a irrtposition ger ,and civil and/or criminal penalties.
Signature of Purchaser Date d
Printed Name DIANA L CORDRAY Title CLERK-TREAURER
The Indiana Department of Revenue may request verification o registration in another state if you are an out-of-state purchaser.
Seller must keep this certificate on file to support exempt sales.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fred Pryor Seminars
IN SUM OF$
PO Box 219468
Kansas City, MO 64121-9468
' r
$179.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 1 17089836 1 43-570.041 $179.00 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
k4 &I J
Fr' , F 115
reek
S reet Commissioner
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))
02/25/15 17089836 $179.00
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