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Home My WebLink About323494 03/29/18 CITY OF CARMEL, INDIANA VENDOR: 362629 ONE CIVIC SQUARE INDIANA DIV OF INTNTL ASSOC FOR ICCHECK AMOUNT: $.....**120.00* CARMEL, INDIANA 46032 550 W.16TH STREET,SUITE C CHECK NUMBER: 323494 vy_TON.`o ATT:SEAN MATUSKO CHECK DATE: 03/29/18 INDIANAPOLIS IN 46202 ` DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4355300 120.00 ORGANIZATION & MEMBER VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) Vendor# 362629 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER INDIANA DIV OF INTNTL ASSOC FOR ID IN SUM OF$ CITY OF CARMEL 550 W. 16TH STREET, SUITE C An invoice or bill to be properly itemized must show:kind of service,where performed,dates service ATT: SEAN MATUSKO rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46202 Payee $40.00 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police 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 43-553.00 $40.00 1 hereby certify that the attached invoice(s),or 3/19/18 0 annual membership-Lane,Pilkington $40.00 1110 101 1110 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 Tuesday, March 27,2018 Jim Barlow 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 ��a��NA�ASS/py INDIANA DIVISION OF Z THE INTERNATIONAL ASSOCIATION FOR o= IDENTIFICATION TIF��' MEMBERSHIP RENEWAL FORM Please complete this form to renew your Indiana IAI Membership for the coming year. Return the signed form with a check or money order fortS000'payab a 1nd) visi� 1ily' to the Secretary-Treasurer at the address below, OR you may scan the signe orm an a o the ecretary-Treasurer at the email address below and pay through PayPal on our website at www.iniai.ora/membership. The information on this form will be used to prepare the Member Directory, so please check addresses, telephone numbers, and email addresses for accuracy. Your membership letter will be sent upon receipt of your renewal form and payment. Sean Matusko, Secretary-Treasurer 550 W 16th St, Suite C Indianapolis, IN 46202 sdmatusko(cDamail.com Federal Employer Identification Number: 35-1934954 Indiana IAI Member Number:1,uSoq Membership Level: WActive ❑Associate Name:,. �Z11ti�i kv►� '�n,C.- Are you a Member of the IAI Parent Body? ❑ Yes: Member Number: ❑ No Employer(Agency or Company): C ,1;4't1vl l"G jl U,„, Ci i'�of&'At Title or Position: �i'li��Z ° civ 111V(.S'j o t;M-V", Office Address: 5 bVi c. S"LU'cL✓v J City: Gill/,pu, State: ;iti Zip Code: 4�5� Office Telephone Number: (311 ) 511 - 2_511- Fax Number: (311 )5-11 - 2-51_ Office Email Address: ` t (tih.& u (C-,4�1�� , t 1�1 , (�o4 Changes from Prior Year: M P- I wish to renew my membership in the Indiana Division of the International Association for Identification. I continue to meet all the requirements as stated in the Constitution and Bylaws. /1 Member's Signature. 46`L Date' l 1--.x IAI Office Use Only J Received: Form of Payment: Receipt Number: Record Updated: Member Notified: `ANA AS�S/ INDIANA DIVISION OF Z THE INTERNATIONAL ASSOCIATION FOR IDENTIFICATION TIF��'P�`o2 MEMBERSHIP RENEWAL FORM Please complete this form to renew youLj, gdiangjA1.V_eMboeip for the coming year. Return the signed form with a check or money order fo $ �is >a Ina Dni'rsion IAI " to the Secretary-Treasurer at the address below, OR you may scan the signed form and email it to the Secretary-Treasurer at the email address below and pay through PayPal on our website at www.iniai.org/membership. The information on this form will be used to prepare the Member Directory, so please check addresses, telephone numbers, and email addresses for accuracy. Your membership letter will be sent upon receipt of your renewal form and payment. Sean Matusko, Secretary-Treasurer 550 W 16th St, Suite C Indianapolis, IN 46202 sdmatusko(cD-gmail.com Federal Employer Identification Number: 35-1934954 Indiana IAI Member Number: _rAl 53cl Membership Level: Active ❑ Associate Name: ��. P: f k�►�r� i►-. Are you a Member of the IAI Parent Body? ❑ Yes: Member Number: 16�LNo Employer(Agency or Company): Car,��P Title or Position: Office Address: 3 C(VLC_ s egwart City: C C'.e- State: fir/ Zip Code: 14(e o3 Z Office Telephone Number: ( 3C? ) 571- 2,514 Fax Number: ( 3 /? ) 57 Office Email Address: '5P► //<I 4� lW �a rw�a-Q. +ri .� v✓ Changes from Prior Year: I wish to renew my membership in the Indiana Division of the International Association for Identification. I continue to meet all the requirements as stated in the Constitution and Bylaws. Member's Signature: �6_ Date: 31/3118 IAI Office Use Only Received: Form of Payment: Receipt Number: Record Updated: Member Notified: Prescribed by State Board of Accounts City Form No.201(Rev.1995) VOUCHER NO. WARRANT NO. Vendor# 362629 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER INDIANA DIV OF INTNTL ASSOC FOR ID IN SUM OF$ CITY OF CARMEL 550 W. 16TH STREET, SUITE C An invoice or bill to be properly itemized must show:kind of service,where performed,dates service ATT: SEAN MATUSKO rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. INDIANAPOLIS, IN 46202 Payee $80.00 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police 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 43-553.00 $80.00 1 hereby certify that the attached invoice(s),or 3/21/18 0 membership application-Sutton $80.00 1110 101 1110 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 Tuesday, March 27,2018 &. e�q� Jim Barlow 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer For Membership#: a IAI International Association O se Date Received: ` for Identification Only Payment Type: Amount Recd: RETURN APPLICATION AND PAYMENTTO: International Association for Identification N�r" 2131 Hollywood Blvd., Suite 403 es78��US/Non Us",Apollo 'ii Amount,❑$45 US/Non-US Student Applicant Hollywood, FL 33020 USA Office (954) 589-0628 Other ❑$800 Sustaining Membership Fax (954) 589-0657 Optional ❑$7 IAI Member Lapel Pin w Email: gcalhoun@theiai.org Website:www.theiai.org F1w Active Membership is foran individual activelyengaged as an examiner,analyst,practitioner,orsupervisor in the forensic sciences.Theterm"actively engaged"is defined as an individual's principle professional endeavor or an ancillary enterprise comprising a significant amount of professional activity. Associate Membership is for an individual wholly or partially engaged in the forensic sciences who is not qualified for Active Membership. Associate members are subject to the same rules,fees, and charges, and are entitled to all rights and privileges of Active membership,with the " exception that they are not entitled to hold the office of President or Vice President of the IAI. Student Membership is for a full-time college student majoring in forensic science or law enforcement.Applicants must include a letter or current transcript from their educational institution certifying the applicant is currently taking at least 12 semester credits or the equivalent in quarter credits for undergraduate study.At least 9 semester credits or the equivalent in quarter credits is needed for graduate study applicants.The letter must state the number of credits being taken.The words"full-time student"will notsuffice. :. Sustai ni ng Active orAssociate Members hip is for an individual who meets the defined criteria as stated above forActive orAssociate Membership and ;• prefers to make one payment(which is 10 times the current annual dues amount)and eliminates the requirement of annual dues. "` Membershipapplyingfor: Active❑Associate❑Student❑SustainingActive [:]Sustaining Associate Full Name KoLff-n W n 1<o-iYIeLk-e- '� I � First Name Middle Name Last Name a - Have you ever been convicted of a crime? ONO ❑ Yes(If yes,please provide details on a separate sheet of paper.) Work/Student Title aIWIe- SC,Q_02 lr�V gS J�aA15Y• 4a e r Home Address utrtu CA treet Apt/Floor/Suite Number 9 etae�l I►� �t� 32 USA r city State/Province Postal/Zip Code Country � 1 � Employer/School t>-f Ca Lwe_`t- 4bU Le kvCLOML 4 r Work/School Addressa��C _S2uhXe— x Street Apt/Floor/Suite Number Yt 0 Ca rnel !f-J 4(py32- USA Ciry State/Province Postal/Zip Code_ Country wSend IAI mail/publicationsto: ❑ Home ❑✓ Work[:11 will access on IAI Website Listthis address in the IAI Directory: ❑ Home VWork 01, Home Phone Work Phone Ext. Cell Phone L-�k2� Fax Phone t: Email Address C 4a"m e- , t N • Aon/ i Recommender SL0-0-?< <k LX 31131 a (Preferred but not Mandatory) IAI Member NameIAI Member Number IAI Member Si ture ' x" a� IAI Member Phone Number IAI Member Email For IAI Office Use Only Approved Approved . Regional Representative or Sub Committee Chair(signature anddate) Chief Operations Officer(signature and date) T� PLEASE NUMBER UP TO THREE AREAS OF EXPERTISE Instructions:Write"I"for your primary discipline and then"T and"T'for the other areas. Biometrics Information Systems Forensic Photography&Electronic Imaging Bloodstain Pattern Analysis Forensic Podiatry I Crime Scene Investigation General Forensics(select if one of the below applies) Digital and Multimedia Evidence ❑Forensic Biology/DNA Facial Identification ❑Firearm&Tool Mark Examination 2 Latent Print Development ❑ Forensic Anthropology Latent Print Identification ❑Forensic Odontology r- ur i 3 Footwear&Tiretrack Examination ❑Questioned Documents Forensic Art Tenprint Identification -', 'The[Al currently offers certifications in the following disciplines. Please go to the IAI website(Mm.lheiai.oro)and click on the"Certifications"link for details. Bloodstain Pattern Analysis Footwear Examination Forensic Photography Latent Print Examination Come Scene Investigation Forensic Art Forensic Video Tenprint Examination List job duties,education,interests,and/or experiences in the forensic science field.Attach additional information if needed. M j' s k I understand an application fee paid between January 1 and September 30 will be applied to the membership dues for that calendar year only;if paid between October 1 and December 31,the fee will be applied to the following calendar year. I understand an application must include payment of the application fee,which will be refunded if the application is rejected. I understand my Membership Certificate is the property of the IN and must be returned upon my resignation or suspension. p I understand that omission or falsification of information will be a basis for rejection or denial of IAI membership.To the best of my knowledge,I certify the information contained herein istrue. I hereby submit an application for membership in the International Association for Identification in accordance with its Constitution and By-Laws and :. agree to be bound by them. 3 113 "s Applicant Signature Date CREDIT CARD PAYMENT Please complete ALL information below for authorization.Thank you! ❑Visa ❑ MasterCard ❑Discover/Novus ❑American Express Credit Card Number Security Code Expiration Date(month/year) Print Name(as it appears on credit card) Email Address to Send Receipt Revised 2-2017