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Home My WebLink About321757 02/13/18 1 d_C,Ab CITY OF CARMEL, INDIANA VENDOR: 372210 g ONE CIVIC SQUARE NY ACADEMY OF FIRE SCIENCE CHECK AMOUNT: $****"**139.00* ?° CARMEL, INDIANA 46032 600 COLLEGE AVE CHECK NUMBER: 321757 9"�'iroN`io� MONTOUR FALLS NY 14865 CHECK DATE: 02/13/18 ' DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4357004 101320 139.00 REGISTRATION FEE VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) Vendor# 372210 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER NY ACADEMY OF FIRE SCIENCE IN SUM OF$ CITY OF CARMEL 600 COLLEGE AVE 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. MONTOUR FALLS, NY 14865 Payee $139.00 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR 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 101320 0 43-570.04 $139.00 1 hereby certify that the attached invoice(s),or 2/2/18 0 $139.00 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 02,2018 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 NEw Fire Prevents®n Registration Form ®RK Fire Academy and Regional Technical Rescue sTA E and Contr®l New York State Academy of Fire Science 600 College Ave.,Montour Falls,NY 14865-9634 (607)535-7136;Fax:(607)535-4841 Personal Information Sponsoring Organization NAME(Last,First,MI) FIRE DEPARTMENT ID# COUNTY r'�� `� -r O96-03 Al�oll-� TRAINING IDENTIFICATIO NUMBER SPONSORING ORGANIZATION 0;444 ��E HOME ADDRESS(Street,P90M) STREETADDRESS,PO BOX /-J//-7 / -v- -Z C/0 C sQVhe16 CITY ST TE � ZIP � � CITY STATE ZIP FD PHONES#�J! FID E-MAIL or FAX LlCHECK IF NEWADDRESS MALE ❑ FEMALE (Do / Z6 NAMEMTLE-HEAD OF THE SPONSORING AGENCY DAYTIME PHONE — EVENING PHONE '31,Z16 ``� S Al SIGN U E- D O THESP N ORING ENCY FAX# E-MAILADDRESS FIRE ACADEMY COURSE CODE# COURSE TITLE DATES: 01-10-0012 Fire and Life Safety Educators' Conference May 4 - 6, 2018 Course Registration - Registration, Material and Accommodations Fees: NOTE: Payment MUST Accompany Registration Registration Fee is MANDATORYAND NONREFUNDABLE Registration Fee (include w/registration) $ Ll NYS Resident-$25 Out-of State-$50 Materials Fee (if applicable—payable upon arrival) $ $5 Accommodations Fee (payable upon arrival) $� Materials Fee (if applicable) payable upon arrival See course description (may not include required text book) Optional commuter dinner(s) $ ❑ Prerequisite Proof(if applicable) Total enclosed: $ Must accompany registration Balance due upon arrival: $ ,s'W-0 Academy Accommodations -payable upon arrival 15 1.14 Resident—includes Meals&Lodging -$84 Reasonable accommodation request: ❑ Commuter—includes breakfast&lunch -$20 ❑ Commuter dinner-$9/day (optional) Share room with: Payment Method Make checks, money orders &vouchers payable to: ❑ VISA ❑ MasterCard ❑ Discover Total Charge: $ Academy of Fire Science Card# ❑❑❑❑ ❑❑❑❑ ❑❑❑❑ ❑❑❑❑ ❑ Check ❑ Money Order ❑ Signed Voucher i Purchase Order Expiration Date[][]/[][] Security Code[][][] ❑ Bill Meals&Lodging to Student ❑ Bill Meals&Lodging to Sponsoring Organization Signature Please review the application to make certain it is-complete and the required payment and prerequisite proof are enclosed. This form is on the web at www.dhses.ny.gov/ofpc • MAIL OR FAX APPLICATION TO FIRE ACADEMY ONLY NOTE:Due to participant demand,the deadline for all Academy course registrations is 20 days before the course start date.If your registration is not received by this deadline, we cannot guarantee placement in the requested course. Call the Academy for further information. 1220(10108)