HomeMy WebLinkAbout308566 02/28/17 ,C.IA .
;y "^ CITY OF CARMEL, INDIANA VENDOR: 370436
,{ ONE CIVIC SQUARE INDIANA INDUSTRIAL OPERATORS ASMECK AMOUNT: $.....***50.00*
:9 ?Q CARMEL, INDIANA 46032 5439 N.NFIE CORN OURT CHECK NUMBER: 308566
M. CHECK DATE: 02/28/17
lrpN G
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 DUES 50.00 OTHER EXPENSES
Q0A
4� Indiana Industrial Operators Association, Inc. (IIOA)
5439 N. Acorn Ct., Greenfield, IN 46140
2017 IIOA Annual Membership Renewal Form
Please review your member information and make any necessary corrections and return or fax to 110A
Fax 317.823.8916 or email to: marlin(djioa.net Tip:(use your phone camera to take a pix ofform to email)
Membership Expires: 12/31/2016 Visit the Newly Designed 110A website . . . iioa.net
City of Carmel
Attn: Teresa Lewis Title: Manager of Customer Relations &Education
3 0 W. Main Street
Carmel, IN 46032
❑ Check Box for a Receipt !
Company Information: Company Name: City of Carmel
-Street: 30-W: Main-Street -
City: Carmel State: IN Zip: 46032
Company Tel. 317-571-2477 Company Fax: 317-571-2265
Company Email: tlewis@carmel.in.gov
Home Information:
Street:
City: State: Zip:
Home Tel.: Fax: Cell:
Home Email: Mail to (Please Circle)Home or Work
Licensed Operator Information:
Industrial Number: Class: Expires: 6/30%
Municipal Number013` '6 Class_V.Expires: 6/30/ 1-1
HOA Annual Membership Dues: $50.00
Please make checks payable to IIOA and either mail or fax form to 110A Fax:317.823.8916
Voice Line: 317.823.9042 Credit Card Payments-We accept most major cards
Card Number: Expires: Verification Code:
Signature: Name on Card:
Zip Code where credit bill is received:
VOUCHER # 167156 WARRANT # ALLOWED
370436
IN SUM OF $
INDIANA INDUSTRIAL OPERATORS A;
5439 N Acorn C
Greenfield, IN 46140
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
DUES 01-7040-08 50.00
Voucher Total 50.00
Cost distribution ledger classification if
claim paid under vehicle highway fund