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311214 5/9/2017 4��,�,',F( CITY OF CARMEL, INDIANA VENDOR: 00352385 a; .; � �"• ONE CIVIC SQUARE ROBERT L. SMITH, PHD CHECK AMOUNT: $*****2,000.00* =q CARMEL, INDIANA 46032 429 E VERMONT ST SUITE 11 CHECK NUMBER: 311214 ' INDIANAPOLIS IN 46202 CHECK DATE: 05/09/17 ETON� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 R4357003 24934 2,000.00 PEER SUPPORT AND AID tN ;o $ < k E ?m a\ 3 ow # k m k 0 i / > f % 3 E o q \ \ k z / % o Q a z / z % E m n 0 # A a a W _ @ -nq « ƒ ` § ] >/ m \ C� q> c T. » q E § 3 § © a d � . \ k 2 E r > -n9 ( o 0 | E § c CD 8 t _ 5 a i g � - 2 # / \ \ \ / / / m ` ^ ° m c $ M \ § _ O k a. k CDC I k f k ( ( CL CD - E m I m ! E ; m k E ® $ ( Q O FD. @ o E_ R ° g % C _ o M I E B o w CL § - a 0) & { i ± q § 2 / ra # Q - 7 %« , m m § CL , Ea I ` - m \ [ CY� \3 0 D ® / & § \ _ < � Q 0 _ o }} § ) ƒ \ k C CL o CD '5 3 / £« ' " C } o &� % CD 0< \ CD e° 0Q D }f m \ { §_/ & E �E \ I \ r ? q 0 { 0 / 2 \ E C \ \ r- O E 3 ) \ C c m D % ( $ E m \ & q CD 0) 0 ID M \ \ CL CD / \ } \ k � \ \ E q > & Q \ ° / 0 ° CD jD k \ Robert L. Smith, Ph.D. 429 E.Vermont St. Suite 11 Indianapolis, IN 46202 (317) 283-6360 Services Date 04/27/2017 Treatment Consultation Individual-90843 Mediation Group-90853 Family Negotiation Family-90847 Supervised Visitation EAP-90899. xSeminar Patient/Client Carmel Fire Department 2 Civic Square Carmel,IN 46032 INVOICE DATE SERVICE TIME AMOUNT 05/01/17 Basic Peer Support training. 8 hours $1000.00 05/02/17. Psychological First Aid for 8 hours. $1000.00 Fire and EMS Balance. $2000.00 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