HomeMy WebLinkAbout182626 02/18/2010 CITY OF CARMEL, INDIANA VENDOR: 152500 Page 1 of 1
ONE CIVIC SQUARE INDIANA LEAGUE OF MUN CLERKS 8 T RECK AMOUNT: $185.00
CARMEL, INDIANA 46032 C/O KAREN CHASTEEN
50 N 5TH STREET CHECK NUMBER: 182626
RICHMOND IN 47374
CHECK DATE: 2/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355300 185.00 SHEEKS /CORDRAY
ILMCT ANNUAL DUES NOTICE
Claim and Invoice
This invoice and claim for payment is made upon the Clerk or Clerk- Treasurer of the City or Town for
payment of membership dues for the Indiana League of Municipal Clerks and Treasurers. You
may pay from this invoice any class of membership. Please check the appropriate box to indicate the
actual class of membership and dues schedule that applies.
2010 Dues for all Classes of Membership due on or before March 30, 2010
Active Members:
Towns with population under 700 40.00
Towns with population of 701 to 5,000 50.00
Towns with population of 5,001 to 20,000 75.00
Tj Nns with population of 20,001 to 35,000 $100.00
Towns with population over 35,000 GG $150.00
Please indicate your municipality's population
Active Member Name:
Title (Circle One): Clerk Treasurer jerk Controller
Certification (Circle all that apply):C M� CIVIC MMCA MMC CMFA
Name of Municipality: V' nom! County: 1r1Ftc�
Office Address: Ci U L U e-
City/Town/Zip: 4, E_ �l V 7010 3 -2 1
Office Phone: `l Fax:
Office e -mail: C i2&TGJ
Home Address: City/Town/Zip:
Home Phone: oil �0 _W
ILMCT Membership Benefits Include:
A membership card denoting your affiliation
Notice of League events (includes training and professional development opportunities)
A subscription to the Quest, the ILMCT official newsletter
In some cases, discounts for League sponsored events.
Access to League website www.ILMCT.orq
Associate Member $35.00
(any former active member or staff of an active member of the league):
Associate Member Name: (3t blc� L S Title: a
Address: 01 Gl tC City/Town /Zip: am"V�
Associate Member Name Title:
Address: City/Town /Zip:
(Please copy form for additional Associate Members)
Affiliate Member $35.00
(any person who is elected or an appointed officer in municipal government who is not already qualified for another
membership class may enjoy all League privileges, except the right to vote and hold office.)
Associate Member Name: Title:
Address: C4/Town /Zip:
Associate Member Name Title:
Address: City/Town /Zip:
(Please copy form for additional Affiliate Members)
Associate Business Member: $150.00
(entitled to four (4) membership cards, a membership roster, a Quest subscription and meeting notices)
Associate Business Name: Phone:
Address: City /State /Zip:
1. Primary Contact Name: e-mail:
Address (if different from above)
2. Card Bearer Name: e-mail:
Address (if different from above)
3. Card Bearer Name: e-mail:
Address (if different from above)
4. Card Bearer Name: e
Address (if different from above)
TOTAL ACTIVE MEMBER: Checks to be made payable to the
TOTAL ASSOCIATE MEMBER: Indiana League of Municipal Clerks
TOTAL AFFILIATE MEMBER: Treasurers and mailed to:
TOTAL ASSOCIATE BUSINESS MEMBER: ILMCT c/o Karen Chasteen
50 N 5"' Street
TOTAL AMOUNT ENCLOSED: Richmond, IN 47374
1 hereby certify that the foregoing is just and correct, that the amount claimed is legally due after allowing for just
credits and that no part of the same has been paid.
,767W& 6&J &M, Treasurer,
PLEASE RETURN A COPY OF THIS INVOICE /CLAIM WITH REMITTANCE!!!
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 Rev. 1995)
CITY OF CARMEL
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.
Payee
07 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
�,A� W ALLOWED 20
IN SUM OF
1 b t�
4
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #ITITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund