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Home My WebLink About253320 01/15/16 9,+W"C,A'h �/ CITY OF CARMEL, INDIANA VENDOR: 365130 ONE CIVIC SQUARE MARK CROMLICH CHECK AMOUNT: S'""`1,392.66* FISHERS CARMEL, INDIANA 46032 12685 LANTERN RD CHECK NUMBER: 253320 �y;�ioN�` FISHERS IN 46038 CHECK DATE: 01/15/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4128000 1,392.66 TUITION REIMBURSEMENT VOUCHER NO. WARRANT NO. ALLOWED 20 Mark Cromlich IN SUM OF$ ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 41-280.00 $1,301.60 1 hereby certify that the attached invoice(s), or 1120 41-280.00 *-" bill(s) is(are)true and correct and that the 'c materials or services itemized thereon for which charge is made were ordered and received except ,72 3 7 � Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund rescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL ,n invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by Thom, 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%Tuition $1,301.60 Books $97.44 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 v r City Of Carmel Tuition Reimbursement Application Form Part I(to be completed by Employee) (Pleaseprint.//Submit completed form prior to Department Head or to date course begins.) Employee Name 1401,l�L Date b av 91( Department el\C& Job Title SQ-mn, CAe_7— Educational Institution* s,-� Name of Course** dM b li 14w41y'e-iA04is an/] 45/L� � EM#5 S redit Hours � Starting Date of Course(month/day/year)2 N�/ S 41 ' ` & B signing below,I signify that I understand the following: Se- • The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2--58. G 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 s ject to federal law,which may change from time to time. Employee Signature Date Part H (to be completed by Department Head) By signing below,I certify that: • 1 have read the course description attached to this application and believe this course will maintain or improve the employee's job-related skills, in relation to either the employee's current position or potential career path within my department. • The applicant will have been employed full-time by the City for at least one (I) year prior to the commencement of the course,and has not been subject to a disciplinary probation, suspension or demotion within 90 days prior to the beinning of the course. ® The final.claim will be paid r m my department's budget, subject to the terms of Section 2-58 of Carmel City Code., c Department Head Signature Date d l2 /Jr Part III (to be completed by Director of Human Resources) Final Approval I �` �'�' �Z � Date If denied,reason for denial * The tuition reimbursement program covers only 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 from the school's literature is attached. Registration History Page 1 of 2 'Registration--1--l-istory- -- --- -- -- -- -_ _ _ -- - - The following shows completed registrations, withdrawals and waitlisted courses. Look I under the status column to determine course status. —Spring 2016 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 25487 BED 616 Research Methods 3.000 Graduate —Web Registered" Dec 17,2015 25549 EDPS 520 Introduction to the Gifted 3.000 Graduate "Web Registered" and Talented Student Jan 05,2016 Fall 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade W1114222 EMHS 589Emerge cy Response 3.000 Gradu Web Registered* A WMDs — A 0 2015 — Summer 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 30371 TEDU 550 CTE Student Organizations 3.000 Graduate "Web Registered" A May 11,2015 30373 TEDU 696 Coordinating Coop 3.000 Graduate "Web Registered" A Programs Mar 27,2015 34607 TMFG 560 Occupational Safety and 3.000 Graduate -Web Registered" A Health Mar 27,2015 Spring 2015 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 20587 TEDU 569 Organization Coordination 3.000 Graduate "Web Registered" A CTE Nov 13,2014 Fall 2014 CRN Course Course Title Credits Level Status Midterm Final Grade Grade 15158 TEDU 552 Strategies and Materials 3.000 Graduate "Web Registered" A CTE Aug 17,2014 15159 TEDU 568 Principles and Philosphy 3.000 Graduate "Web Registered" A CTE Aug 17,2014 Active Registration Look Up Classes Course Add/Drop/Withdrawal Institutional Holds RELEASE: 6.0 SITE MAP https://prodssb.bsu.edu/PROD/bwskhreg.p_reg_-iist 1/5/2016 -CASHNet Page 1 of 1 Ball State University Bursar and Loan Administration - eBill System Receipt Number: 510451 Customer: CROMLICH, MARK BSU ePayment Current Date: 09/20/2015 Description Amount Payment on Account $1,643.27 Total $1,643.27 Payment Submitted Amount BSU ePayment ACH $1,643.27 Checking Account XXXXXX271]s Routing ANK NA, NAPERVILLE, IL Total $1,643.27 Thank you for https:Hcommerce.cashnet.com/cashnetg/selfserve/PrintableReceipt.aspx?IXDS=O&Z=VP 1/5/2016 PAYMENT SUMMARY B :A -LL LyT -LAT E Statement Date: 08/14/2015 Ball State ID: 900973497 U N I V E R S I T Y. Previous Balance: $0.00 Office of Bursar and Loan Administration Current Balance: $1,627.00 Muncie, Indiana 47306=0725 Due Date:. 09/01/2015 765-285-1643 www.bsu.edu/bursar • $406.75 • A A • $1,627.00 Mark A. Cromlich 12685 Lantem Rd Fishers, IN 46038-1040 -- --- - - - - --- -- - - - - - -- - - - - - - - - - - - --- - - - - - --- - - ---- - If you are mailing a payment, include the top portion.Keep the lower portion for your records. DATE STATEMENT ACTIVITY CHARGE *BALANCE FORWARD 08/10/2015 Student Recreation Fee $29.00 08/10/2015 University Technology Fee $58.00 08/10/2015 Student Transportation Fee $20.00 08/10/2015 Tuition Basic Grad $1,158.00 G 08/10/2015 Tuition Student Services Fee $362.00 *CURRENT BILLED BALANCE* $1,627.00 TOTAL AMOUNT DU $1,627.00 ***ATTENTION! NEW PAYMENT OPTIONS EFFECTIVE FALL 2015!***No sign up required,just pay by one of the followin ions each month: 1)TOTAL AMOUNT DUE-or-2)DEFERMENT AMOUNT*. Your monthly payment will indicate the choice you have made. If paying the DEFERMENT AMOUNT by the Due Date you will incur: 1st Month:$30 DEFERMENT FEE,2nd Month:$15 DEFERMENT FEE,3rd Month:$15 DEFERMENT FEE. If payment is late or less than the DEFERMENT AMOUNT,a 1%LATE FEE will be assessed on past due current term charges. Be sure your student has given you access to bean Authorized Payer and a Proxy. Authorized Payer allows online eBill access while Ball State's Proxy access allows us to discuss your records on your behalf. Learn more on all of the above information at www.bsu.edu/bursar. If you'd like to mail payment,please use the address above. *DEFERMENT AMOUNT is not offered in the Summer,TOTAL AMOUNT DUE will be your only payment option. Name:Mark A.Cromlich Ball State ID:900973497 Statement Date:08/14/2015 Page 1 of 1 Page 1 of 3 Customer Service 1.800.955.7070 Aug.16-Sep.15,2015 31 Days in Billing Cycle 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 Oct 12,2015 Minimum Payment 14 Years qm 1 3 Years PLEASE PAY AT LFASi THIS AMOUNTYour estimated savings if you pay off this balance in 3 years: Credit Limit: Cash Advance Credit Umit:$1,500.00 If you would like information about credit counseling services,call 1-888-3268055. AvailableCredtt Available Credit for Cash Advances:$1,162.14 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°/x. Previous Balance Payments and Credits Fees and Interest Charged Transactions New Balance q=M — �! + + miiim = �f TRANSACTIONS REWARDS INFORMATION PAYMENTS,CREDITS&ADJUSTMENTS FOR MARK CROMLICH#8373 PREVIOUS AVAILABLE REWARDS BALANCE !� 1 REWARDS EARNED THIS PERIOD (reflects transactions posted during this billing cycle) AVAILABLE BALANCE AS OF 09/15/2015 VOW 2 16 AUG Amazon.comAMZN.COM/BILLWA $77.44 For up-to-date rewards tracking,visit www.capitalone.comi AIOMISSte rewards or simply call 1-800-2283001 INTEREST CHARGE CALCULATION Your Annual Percentage Rate(APR) is the annual interest rate on your account. Type of Balance Annual Percentage Balance Subject to Interest Charge Rate(APR) Interest Rate Purchases 22.90%P #MOM $60.08 Cash Advances 24.90%P am $0.00 P,L,D,F=Variable Rate.See reverse of page 1 for details PLEASE RETURN PORTION BELOW WITH PAYMENT OR COG ON TO WWW.CAPITALONE.COM TO MAKE YOUR PAYMENT ONLINE. 1 5178057590788373 15 2337862000000086000 Account ending in 8373 Due Date New Balance Minimum Payment Amount Enclosed ENJOY 24x1 ACCESS TO YOUR ACCOUNT Oct 12,2015 Log in and manage your account online at www.capitalone.com •Pay bills PLEASE PAY AT LEAST •Check your balance THIS AMOUNT •Review transactions 400018 MARK A CROMLICH 12685 LANTERN RD FISHERS, IN 46038-1040 Capital One Bank (USA), N•A- P•O. Box 6492 Carol Stream, IL 60197-6492 rrl1l1rr.IIIIII I-IIIIIII-I-IlrIIrIIIIIIIIIIIII-I'IIII'1111rI-I-II 1 5178057590788373 15 2337862000000086000 r I 9/ 1 f W.. univermy MD., Order Date: 8/18/2015 10:16:47 AM Page 1 of 1 * Order Number: 29011 Shipment: 1 of 1 888107234404 Packing List ID: I Illlll VIII IIT VIII Illll VIII Illll IIII I'll ,; Ordered by: 2803545 l clardinasb o *'c'm Cromlich,Mark Shin to Address: 12685 Lantern Rd. Cromlich, Mark Fishers,IN 46038- 12685 Lantern Rd. Country:United States Ship Method: Pick up at Store Fishers, IN 46038- Phone#: 317-409-0909 Ship Date: 8/19/2015 9:10:43 AM Country:United States Email: macromlich@bsu.edu Notes: yment Information Card Number Exn.Date stercard($20.00) xxxx-xxxx-xxxx-3136 10115 -der Items purse Materials arse IHS 589 Section: 1 Course ID: Instructor: PICHTEL Update Action: Do Not Add to Order IHS 389/589:COURSE PACKET Author: PICHTEL ISBN: Unknown Discount: $0.00 I I I I III I I II' I III III I I III ige: REQUIRED Edition/Status: 62732 Price: $18.69 Extended: $18.69 t in Shipment: 1(New) Already Shipped: 0 Not Shipped: 0 2 818310 162732 -der Summary in Summary Order Totals ctbooks Ordered 1 Item Total $18.69 dbooksPacked 1 Tax $1.31 Shipping $0.00 Handling $0.00 Grand Total $20.00