248038 07/28/1 5 9CAA
CITY OF CARMEL, INDIANA VENDOR: 00352385
;; ® ONE CIVIC SQUARE ROBERT L. SMITH, PHD CHECK AMOUNT: $*****1,000.00"
CARMEL, INDIANA 46032 429 E VERMONT ST SUITE 11 CHECK NUMBER: 248038
.yi,oN.��• INDIANAPOLIS IN 46202 CHECK DATE: 07/28/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357003 1,000.00 INTERNAL INSTRUCT FEE
Robert L. Smith, Ph.D. 429 E.Vermont St. Suite 11
Indianapolis, IN 46202
(317) 283-6360
Services Date 03/26/15
Treatment Consultation
Individual-90806 Mediation
Group-90853 Family Negotiation
Family-90847 Supervised Visitation
EAP-90899 Seminar
Patient:
City of Carmel
Fire Department
Atm.Mark Vosl hul
One Civic Square
Cannel IN 460..
DOB N/A
Claim# N/A
INVOICE
DATE SERVICE TIME AMOUNT
05/01/2015 Training fee for Basic Peer
Support class. (8-hour) $1000.00
Balance. $1000.00
7 Dx: N/A
Robert L.Smith Ph.D Please remit to:
Marriage and Family Therapist Robert L Smith Ph.D
Indiana License#35001420A IRS#32-0196789
Mental Health Counselor
Indiana License#39000576A
'rescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n 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))
$1,000.00
1 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
Robert L Smith
IN SUM OF $
429 E Vermont Street, Suite 11
Indianapolis, IN 46202
$1,000.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-570.03 $1,000.00 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
JUL 2 7 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund