308505 02/28/17 CITY OF CARMEL, INDIANA VENDOR: 368009
.;; Q .�• ONE CIVIC SQUARE CITY OF LEWISVILLE
CHECK AMOUNT: $********70.00*
CARMEL, INDIANA 46032 KTA SYMPOSIUM CHECK NUMBER: 308505
vy(TON � PO BOX 299002 CHECK DATE: 02/28/17
LEWISVILLE TX 75029-3704
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 0 70.00 EXTERNAL INSTRUCT FEE
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 368009
CITY OF LEWISVILLE IN SUM OF$ CITY OF CARMEL
KTA SYMPOSIUM 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.
LEWISVILLE, TX 75029-3704
Payee
$70.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-570.04 $70.00 1 hereby certify that the attached invoice(s),or 2/17/17 0 $70.00
1120 101 1120 101
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
Friday, February 17,2017
David Haboush
Fire Chief
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
1
Print and Mail Completed Form to the Address Below.
Email form if paying by credit card. You will'be contacted for credit card information.
2017 KTA Symposium Registration
The 2017 Registration Fee for KTA is$70 per attendee.
Checks must be made payable to City of Lewisville. To pay by credit card please include a
daytime phone number; you will be contacted to get the necessary information.
YOU WILL NOT BE REGISTERED UNTIL WE RECEIVE YOUR PAYMENT!
Each participant MUST complete the form. Please choose between Pipes and Drums or Honor Guard,but
not both.
Our symposium is for active or retired firefighters.The event is not open to the general public or
personnel who do not serve as firefighters.
** PRINT ONLY **
Name Tom Payne
Department Name Carmel Fire Department
Department City Carmel
Department State IN
Cell# 317-741-0153
Email Address tpayne@carmel.in.gov
Home Address 6572 W. Charleston Way., ----- -. _____
city McCordsville state IN zip 46055
Please circle the apj2roprmate r - ponse:
What are you signing up for(Choose One Only)
HONOR GUARD
Honor Guard Commander Team Member
PIPES
Beginner Intermediate Advanced
DUB
Snare Tenor Bass
Beginner ntermediate Advanced
Will you require transportation from the airport: Yes: No: XX
(Please fill-out flight information on the next page.)