248288 08/12/15 �'c,q, CITY OF CARMEL, INDIANA VENDOR: 365130
J ® ONE CIVIC SQUARE MARK CROMLICH CHECK AMOUNT: $*******916.39*
=a CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 248288
.y�i roN FISHERS IN 46038 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4128000 916.39 TUITION REIMBURSEMENT
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print. ri
Submit completed form to Department Head prior to commencement of course.)
/"/
Employee Name Grk C!�),M I. t,
Department F,,r e- Hire Date
Educational Institution* A a(l 5- y e.
Name of Course**TV/F6`7 0 0 • � S 4lize a,nd 11e6114 Credit Hours
Starting Date of Course(month/day/year) 6
By signing below, I signify that I understand the following:
• The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2-58.
• To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy
of my final grade. To receive reimbursement for books, I must submit an original itemized receipt
or other proof of purchase that links these books to this particular course.
• If I leave City of Carmel employment sooner than one (1) year after the end of this course.. I will
repay the City in full for its tuition and book reimbursements for this course.
• The tax status of reimbursement payments is subject to federal law,which may change from time to time.
Employee Signature _ Date
Part II (to be completed by Department Head)
(Submit to Human Resources)
By signing below, I certify that the applicant will have been employed full-time by the City for at least one (1)
year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension
or demotion within 90 days pri r o the beginning of.the course. The final claim will be paid from my
department's budget,subject to ic t rn s of Section 2-5 'Carni City Code.
Department Head Signature , Date
Part III (to be completed by Director of Human Resources)
Final Approval � �, ="'t''`- Date Ci /S
If denied, reason for denial
* the tuition reimbursement program covers only full-semester courses offered through a degree-granting institution
accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor.
** An application will not be considered complete unless a course description fi•om the school's literature is attached.
A
amazon.cou
X17 SDLhGgjQhb
Your order of May 11,2015(Order ID 104-8236353-1713863)
Qty. Item Item Price Total
1 Supervisors'Safety Manual 10th Edition $106.53 $106.53
National Safety Council---Hardcover
P-3-865C275-)0879122889
This shipment completes your order. Subtotal 5106.53
Have feedback on how we Tax Collected $7.46
Order Total 8113.99
packaged your order?Tell us at Paid via credit/debit $113.99
www.amazon.com/packaging. Balance due $0.00
Returns Are Easy!Most items can be refunded,exchanged,or replaced when returned
in original and unopened condition.Visit http://www.amazon.com/retums to start your
return,or http://www.amazon.corr/help for more information on return policies.
0/DLhG9jQhb/-1 ofI-//CVGS/second/12598592/0513-01:00/0511-16:39 V4
i
Pagel of 3
Customer Service 1-800-955.7070 Apr.16-May.15,2015 30 Days in Billing Cycle
cl
ait www.capitalone.com
MINIMUM PAYMENT WARNING: If you make only the minimum payment each period,you
Will pay more in interest and it will take you longer to pay off your balance.For example:
Platinum MasterCard Account ending in 8373 Payment Amount Each Period If No Approximate Time to Pay Off Estimated
NEW BALANCE MINIMUM PAYMENT DUE DATE Additional Charges Are Made statement Balance Total Cost
$837.14 $25.00 Jun 12,2015 Minimum Payment 6 Years $1,502
$32 3 Years $1,165
PLEASE PAY AT LEAST THIS AMOUNT Your estimated savings if you pay off this balance in 3 years: $337
Credit Limit:$3,500.00 Cash Advance Credit Limit:$1,500.00 If you would like information about credit counseling services,call 1-888-326-8055.
AvailableCredit:$2,662.86 Available Credit for Cash Advances:$1,500.00 LATE PAYMENT WARNING: If we do not receive your minimum payment by your due date,
you may have to pay a late fee of up to$35.00 and your APRs may be increased up to the
Penalty APR of 29.40%.
Previous Balance Payments and Credits Fees and Interest Charged Transactions New Balance
$1,427.09 - $2,017.99 + $0.00 + $1,428.04 = $837.14
TRANSACTIONS REWARDS INFORMATION
PAYMENTS,CREDITS&ADJUSTMENTS FOR MARK A CROMLICH#8373 PREVIOUS AVAILABLE REWARDS BALANCE $90.26
1 19 APR CAPITAL ONE MOBILE PYMTAuthDate 19-APR ($1,430.09) , e o-
RF:.iARI)S iil;C.idED THLS PERIOD 2".,
2 19 APR MENARDS 3171 FISHERSINDIANAPOLISIN ($7.48) (,refers U.rlsarties>,cstetJ during this i,illing cycle)
3 20 APR MENARDS 3171 FISHERSINDIANAPOLISIN ($32.06)
4 03 MAY CREDIT-CASH BACK REWARD ($98.36) REDEEMED THIS PERIOD 08.36)
5 03 MAY CAPITAL ONE MOBILE PYMTAuthDate 03-MAY ($450.00) ,^,vAHABLF:BALAINCE AS OF 05""5/2.0 S
TRANSACTIONS FOR MARK A CROMLICH#8373 For up-to-date rewards tracking,visit
1 16 APR COCA COLA BLOOMINGTON BLOOMINGTONIN $3.00 www.capitalone.com (.✓NoHassle rewards
2 17 APR SUNOCO 0811060300 QPSIASPERIN $35.44 or simply call 1.800.228.3001
3 18 APR AMERICAN LEGION POST#FISHERSIN $94.84
4 19 APR BLK`HABITAT FOR HUMAN13179212121 CA $50.00
5 19 APR MENARDS FISHERSINDIANAPOLISIN $22.53 INTEREST CHARGE CALCULATION
6 19 APR MENARDS FISHERSINDIANAPOLISIN $32.06
7 19 APR DICK'S CLOTH ING&SPORTI IN DIANAPOLISIN $7,98 Your Annual Percentage Rate(APR) is the annual interest rate on your account.
8 19 APR HOT BOX PIZZA-NOBLESNOBLESVILLEIN $15.51 Type of Balance Annual Percentage Balance Subject to Interest Charge
9 20 APR JIMMY JOHN'S#578CARMELIN $11.50 Rate(APR) Interest Rate
10 23 APR MCDONALD'S F33047FISHERSIN $5.81 Purchases 22.90%P $0.00 $0.00
11 23 APR INDIANA CC CONCESS 0071NDIANAPOLISIN $10.63 Cash Advances 24.90%P $0.00 $0.00
Transactions continue on page 2 P,L,D,F=Variable Rate.See reverse of page 1 for details
PLEASE RETURN PORTION BELOW WITH PAYMENT OR LOG ON TO WWW.CAPITALONE.COM TO MAKE YOUR PAYMENT ONLINE.
1 5178057590788373 15 0837140450000025009
Account ending in 8373
Due Date New Balance Minimum Payment Amount Enclosed
ENJOY 24/7 ACCESS TO YOUR ACCOUNT
Jun 12, F$837,14 $25.00 Log in and manage your account online at www.capitalone.com
•Pay bills
PLEASE PAY AT LEAST •Check your balance
THIS AMOUNT •Review transactions
40001R
MARK A CROMLICH
12685 LANTERN RD
FISHERS, IN 46038-1040 Capital One Bank (USA), N-A-
P.O. Box 6492
Illtltl Carol Stream, IL 60197-6492
"IIII,�,1111111'1111111'I'll'll'lllllllllllll'I'llll'llll'I'I'll
1 5178057590788373 15 0837140450000025009
Page 2 of 3
Customer Service 1-800-955.7070 Apr.16-May.15,2015 30 Days in Billing Cycle
Cap/fa,lQie- www.capitalone.com
Credit Limit: $3,500.00
Platinum MasterCard Account ending in 8373
Available Credit: $2,662.86
NEW BALANCE MINIMUM PAYMENT DUE DATE Cash Advance Credit Limit: $1,500.00
$837.14 $25.00 Jun 12,2015 Available Credit for Cash Advances: $1,500.00
Previous Balance Payments and Credits Fees and Interest Charged Transactions New Balance
$1,427.09 - $2,017.99 + $0.00 + $1,428.04 0 $837.14
TRANSACTIONS CONTINUED
TRANSACTIONS FOR MARK A CROMLICH#8373(CONTINUED)
12 24 APR INDIANA CC CONCESS 0071NDIANAPOLISIN $4.09
13 24 APR INDIANA CC CONCESS 0071NDIANAPOLISIN $7.09
14 25 APR SQ*EYE SAFETY SYSTINDIANAPOLISIN $60.00
15 25 APR STEAK-N-SHAKE#0224 Q99CARMELlN $38.26
16 25 APR WASHINGTON STREETINDIANAPOLISIN $10.00
17 25 APR REGAL CINEMAS VILLAGECARMELIN $37.50
18 25 APR INDIANA CC CONCESS 0071NDIANAPOLISIN $7.90
19 26 APR SQ*JACK'S DONUTS OF CCarmeIIN $21.33
20 26 APR KROGER#9441NDIANAPOLISlN $31.14
21 27 APR SPEEDWAY 03352 140FISHERSIN $44.07
22 27 APR CLASSIC CLEANERS#11 FISHERSIN $8.97
23 28 APR SOME GUYS PIZZA PASTACARMELIN $12.54
24 29 APR ARBYS 7113CARMELIN $7.06
25 02 MAY PORTER PAINTS 9259FISHERSlN $96.30
26 03 MAY REDBOX'DVD RENTAL866-733-26931L $2.57
27 03 MAY LOWES#00288`INDIANAPOLISIN $78.60
28 03 MAY MENARDS FISHERSINDIANAPOLISIN $158.04
29 04 MAY HOTBOX PIZZACARMELIN $35.34
30 05 MAY MCDONALD'S F32582NOBLESVILLEIN $4.89
31 06 MAY CELLULAR CONN 433FISHERSIN $96.29
32 09 MAY SEARS HARDWARE 5340FISHERSIN $96.21
33 11 MAY SKILLSUSA ORGO703777881 OVA $59.85
34 f1r211MAY!Amazoh comAWZNaCOMZBILLWA:S jgi$i111.L3 9
35 12 MAY TISBOO6SU.COM765-282-18111N $85.96
36 12 MAY MCDONALD'S 1`33047FISHERSIN $4.20
37 12 MAY CLASSIC CLEANERS#11 FISHERSIN $8.97
38 13 MAY JIMMY JOHN'S#578CARMELIN $7.58
Total for Mark A Cromlich#8373 $1,428.04
► Total Transactions This Period $1,428.04
FEES
Total Fees This Period $0.00
INTEREST CHARGED
Total Interest This Period $0.00
TOTALS YEAR TO DATE
Total Fees This Year $39.00
Total Interest This Year $0.00
Academic Transcript Page 1 of 2
STUDENT INFORMATION
Name: Mark A.Cromlich
Birth Date: Apr 04,1969
Student Type: Continuing
Curriculum Information
Current Program
Master of Arts
College: Applied Science and Technology
Major and Department: Career and Tech Education,Technology
***Transcript type:WEBO Official Request via Web is NOT Official***
INSTITUTION CREDIT -Top-
Term: Fall 2014
College: Applied Science and Technology
Major. Career and Tech Education
Student Type: New Graduate Student
Academic Standing: Graduate Good Standing
Subject Course Campus Level Title Grade Credit Quality Start R CEU
Hours Points and Contact
End Hours
Dates
TEDU 552 Online GR Strategies and Materials CTE A 3.000 12.000
TEDU 566 Online GR Principles and Philosphy CTE A 3.000 12.00
Term Totals (Graduate)
Attempt Passed Earned GPA Quality GPA
Hours Hours Hours Hours Points
Current Tenn: 6.000 6.000 6 000 6 000 24 000 4 000
Cumulative: 6 000 6.000 6 000 6 000 24.000 4 000
Unofficial Transcript
Term: Spring 2015
College: Applied Science and Technology
Major: Career and Tech Education
Student Type: Continuing
Academic Standing: Graduate Good Standing
Subject Course Campus Level Title Grade Credit Quality Start R CEU
Hours Points and Contact
End Hours
Dates
TEDU 569 Online GR Organization Coordination A 3.000 12.000
CTE
Term Totals (Graduate)
httnc•//nrnrlcch heti, Prl1i/PR0T)/hwekntrn P ViPwTrsn 7/71/7015
Academic Transcript Page 2 of 2
Attempt Passed Earned GPA Quality, GPA
Hours Hours Hours Hours Points
Current Tenn: 3000 3.000 3000 3.000 12.000 4.000
Cumulative: 9.000 9 000 9.000 9 000 36.000 4.000
Unofficial Transcript
Term: Summer 2015
College: Applied Science and Technology
Major: Career and Tech Education
Student Type: Continuing
Academic Standing: Graduate Good Standing
Last Academic Standing: Graduate Good Standing
Subject Course Campus Level Title Grade Credit Quality Start R CEU
Hours Points and Contact
End Hours
Dates
TEDU 550 Online GR CTE Student Organizations A 3 000 12.000
TEDU 696 Online GR Coordinating Coop Programs A 3.000 12.000
TMFG 560 Online GR Occupational Safely and A 3000 12000
Health
Term Totals (Graduate)
Attempt Passed Earned GPA Quality GPA
Hours Hours Hours Hours Points
Current Tenn: 9.000 9 000 9 000 9 000 36 000 4.000
Cumulative: 18.000 16.000 18 000 18 000 72.000 4.000
Unofficial Transcript
TRANSCRIPT TOTALS (GRADUATE) -Top-
Attempt Passed Earned GPA Quality GPA
Hours Hours Hours Hours Points
Total Institution: 18 000 18 000 18 000 18 000 72 000 4.000
Total Transfer: 0.000 0.000 0 000 0.000 0.000 0 000
Overall: 18 000 18 000 18 000 18 000 72 000 4 000
Unofficial Transcript
Financial Aid Eligibility Menu
httna-//nrnAeeh jkc„ 7710TH 5
BMO ja Harris Bank
A part of BMO financial Group
BMO HARRIS BANK N.A. 125524
P.O. BOX 94033
PALATINE, IL 60094-4033
ACCOUNT NUMBER:
Statement Period
05/24/15 TO 06/23/15
90 09768 IM0099002900000000
MARK A CROMLICH PAGE 1 OF 2
12685 LANTERN RD
FISHERS IN 46038-1040
0
0000
IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR BMO HARRIS ACCOUNTS, PLEASE CALL US
TOLL-FREE AT 1-888-340-2265. BMO HARRIS BANK(R) IS A TRADE NAME USED BY
BMO HARRIS BANK N.A. MEMBER FDIC. EQUAL HOUSING LENDER. NMLS401052 VISIT US
ONLINE AT WWW.BMOHARRIS.COM.
CHECKING ACCOUNTS
EVERYDAY CHECKING MARK A CROMLICH
ACCOUNT NUMBER 0055862708 (Checking)
DEPOSIT ACCOUNT SUMMARY
Previous Balance as of May 23, 2015 3,074.69
2 Deposits (Plus) 3, 082.88
14 Withdrawals (Minus) 5,565.30
Ending Balance as of June 23, 2015 592.27
Deposits and Other Credits
Date Amount Description
May 29 1,533.26 ACH DEPOSIT
PPD Carmel Pay7838 DR DEPOSIT
Jun 12 1,549.62 ACH DEPOSIT
PPD Carmel Pay7838 DR DEPOSIT
Withdrawals and Other Debits
Date Amount Description
May 28 1,369.28 ACH DEBIT
WEB CAPITAL ONE MOBILE PMT
May 29 28.02 ACH DEBIT
PPD INDIANA GAS - VE BILL PAYMT
Jun 02 35.10 ACH DEBIT
PPD AMERICAN FAMILY BILL PAYMT
Jun 04 394.11 POS PURCHASE W/PIN RECORD NO. 477500 CARD NO. 3136
--- COSTCO WHSE 0346 CASTLETON IN
Jun 09 1,00r.-U0- `ACH-DEBIT" -
�__ _---'-- `-- -- _WEB--_BALL STATE UNIV_SCHOOLFEES
Jun 15 7.99�POS PURCHASE r RECORD NO. 351092 CARD NO. 3136
NETFLIX COM NETFLIX COM CA
Jun 17 58.80 POS PURCHASE RECORD NO. 009397 CARD NO. 3136
YMCA OF GRTR INDIANAPO 03177138532 IN
Jun 19 2,000.00 ACH DEBIT
WEB CAPITAL ONE MOBILE PMT
FORM30039
BMO 0,Harris Bank
A part of BM0 financial Group
BMO HARRIS BANK N.A. 125525
P.O. BOX 94033
PALATINE, IL 60094-4033
ACCOUNT NUMBER:
Statement Period
05/24/15 TO 06/23/15
90 09768 IM0099002900000000
MARK A CROMLICH PAGE 2 OF 2
0
Checks by Serial Number
Date Serial # Amount Date Serial # Amount
May 27 9175 120.00 Jun 12 9178 120.00
Jun 01 9176 120.00 Jun 19 9179 120.00
Jun 08 9177 120.00 Jun 10 9181 * 69.00
* Indicates break in check sequence
Daily Balance Summary
Date Balance Date Balance
May 23 3,074.69 Jun 08 2,421.44
May 27 2,954.69 Jun 09 1,418.44
May 28 1,585.41 Jun 10 1,349.44
May 29 3,090.65 Jun 12 2,779.06
Jun 01 2,970.65 Jun 15 2,771.07
Jun 02 2,935.55 Jun 17 2,712.27
Jun 04 2,541.44 Jun 19 592.27
Periodic Account Summary
**************************************************************************
* * Total for This * Total
* * Period * Year-to-date
**************************************************************************
* Total Overdraft Fees *$ .00 *$ .00
**************************************************************************
* Total NSF Fees *$ .00 *$ .00
**************************************************************************
FORNU30039
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mark Cromlich
IN SUM OF$
$916.39
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
I
1120 � Ca $802.40 I hereby certify that the attached invoice(s), or
1120 Q $113.99 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 ]
Fire Chief
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))
80%of Tuition Reimbursement $802.40
Reimburse Books $113.99
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
120
Clerk-Treasurer