186230 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 361329 Page 1 of 1
ONE CIVIC SQUARE CLAY CAMPBELL
CARMEL, INDIANA 46032 9003 MAX COURT CHECK AMOUNT: $803.08
FISHERS IN 46037
CHECK NUMBER: 186230
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 060110 432.68 OTHER EXPENSES
651 5023990 060110 259.60 OTHER EXPENSES
601 5023990 CAMPBELLI 47.48 OTHER EXPENSES
651 5023990 CAMPBELLI 28.50 OTHER EXPENSES
-0,601 5023990 CAMPBELL2 21.76 OTHER EXPENSES
651 5023990 CAMPBELL2 13.06 OTHER EXPENSES
J o
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee) T
(Please print. Submit completed form to Department Head rip 'or to commencement of course.)
Employee Name C, C
Department 'U !VA o f W LA c 4
Hire Date la
Educational Institution*
Name of Course 1 c
Starting Date of Course (month/day /year)
By signing below, I signify that I understand the following:
The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -59.
To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy
of my ftnat grade. To receive reimbursement for books, I must submit the book list for the course
and an original itemized receipt for all books purchased.
If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will
repay the City in full for its tuition and book reimbursements for this course.
The tax status of reimbursement payments is subject to federal law, which may change from time to time.
7 r,7
Employee Signature Date
Part H (to be completed by Department Head)
(Submit to Human Resources)
By signing below, I certify that the applicant will have been employed full -time by the City for at least one (1)
year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension
or demotion within 90 days prior to the beginning of the course. The final claim will be paid from my
department's budget, subject to the terms of Section 2 -59 of Carmel City Code.
f
Department Head Signature r�', Date
Part III (to be completed by Director of Human Resources)
Final Approval Date
If denied, reason for denial
The tuition reimbursement program covers only full semester courses offered through a degree granting institution
accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor.
An application will not be considered complete unless a course description from the school's literature is attached.
V 1%,vv ivly v1aU%,3 i Ztb'G 1 Ul G
Go to Bottom Student Center
Clay Campbell
Search for Classes f Academic Planning My Academics Grades
View My Grades
Spring 2010 1 Undergraduate I IUPUI change term i
Class Grades Spring 2010
Official Grades
Grade
Class Description Units f Grading j Grade; Points
HIST -J 495 PROSEMINAR FOR 3.00 Graded B 9.000
HISTORY MAJORS
Term Statistics Spring 2010
T =rom Cumulative
E IUPUI Student Acct Svcs- Bursar
0 a ff PO Box 6020
Account Statement
W ME �e z ��rs 0' d1. F; %W
Statement Date: 02/02/10 Page 1 of 1 Due Date+ 02/16/10
Billing Reference: IN BILL# XXX1792921 PreviousBalance 0.00
University ID: Minimurr7 Due 448.64
Student Name: Campbell,Clay Samuel Total Due 867.28
Statement notification sent to clscampb @iupui.edu
Charges and Adjustments
01/10/10 Resident Undergraduate Fees 692.28
01110/10 General Fee 175.00
Total Charges and Adjustments: 867.28
Messages
Payingat least the minimum amount due as indicated will enroll you in the payment plan program. There will be a non refundable service charge
Visit our website at http: /osas.iupui.edu for important information about refunds, how and where to pay, and special announcements concerning
If you have questions about your account statement, please contact Student Account Services Bursar; telephone: 317.274.2451 e-mail:
Effective Aug. 1, 2010 new CREDIT CARD CONVENIENCE FEE for IUPUI (Indianapolis Campus only). For more information, please visit the
Make payment online at http:l /onestart.1u.edu
If mailing payment, include the bottom portion of this statement and make check payable to: INDIANA UNIVERSITY
detach
IUPUI Student Acct Svcs- Bursar ...University:.ID. 0001963789
PO Box 6020 Due.Date' 02116/10
Indianapolis, IN 46206 -6020
Minimum Due 448.64
Total Due 867.28
Amount Enclosed;;.;
Campbell,Clay Samuel
9003 Max Ct
Fishers, IN 46037 IUPUI Lockbox
USA Payment Processing Center
PO Box 7245
Indianapolis, IN 46206 -7245
AIUINA000196378900000000086728000000000448645
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Payment Receipt
This is your receipt.
Your payment has been submitted. Thank you.
Confirmation Number: 6227941
Payment Date: May 14, 2010 at 8:59 PM, EDT
Effective Date: May 17, 2010
Primary User Id: 0001963789
Primary User Name: Clay Campbell
Account: Indianapolis
Payment Amount: $942.28
Cardholder's Name: Sara Campbell
Payment Method:
Address Info 9003 Max Court
Fishers, IN 46037
Contact Info: (317)441 -8764 (daytime phone)
Your payment has been received by Indiana University
�lt t11 /(7171tt1'V'.l \7ACYl rrnm/ iii/ nn/ nria�r/ r�rariarPPrintT�a�rmantRpr •Air�t rlr. G/1 �S /7!11!1
6� Back to order details
I all
maclu
Payment Summary Date printed: Apr -10 -10
Status: Paid with PayPal on Apr 10, 2010.
Seller: peseadoe
Buyer: 142star
Shipping
Seller should ship to: Sara Campbell
9003 Max Ct
Fishers IN 46037 -9053
United States
Payment
Item Name Shipping Qty Price
SALOMON GORE -TEX Hiking Boot Shoes Men 13 /US Postal Service Priority Mail: US $10.99 1 US $64.99
48.330413178182 Estimated delivery: April 15 April 16 2010
Subtotal: US $64.99
Shipping handling: US $10.99
Total: US $75.98
Payment instructions: Please use ebay checkout. Paypal it is easy and safe. Click "PayNow" tab and follow through the
process or go directly to www.paypal.com. Thanks!
Payment details: PayPal
e3ay Buyer Protection we'll cover your purchase price plus original shipping. Learn more
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Web site constitutes acceptance of the eBay User Agreement and Privacy Policy.
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httn /na vme.ntq_eha. v_ com /ws eRnvTS A PT.r111?V i ewPavment'�tatus &tra.nSid= 4292[71305014... 4/1 0/2010
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0 s e_ J Onl Sess x Transferd ands Q Pay Bills Send Money Cp� �git mer� 5ervlcee Alerts Appfy for Products
Account Overview Ti ansaction Detail
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Online Statements categorize this transaction now. When you're done, click "Save changes."
Download Transactions
M ama e rate orie5 Completed On: 04/12/2010
Create a banking report Description: CHECK CARD PURCHASE MERCHANT PURCHASE
TERMINAL 449215 PAYPAL CENGKERIK6 6 402 935 7
CA 04 -10 -10 SEQ 010024849036
Amount: $75.98
Transaction Type: WITHDRAWAL
Guaranttee king Personal Note (Optional): Work S
hoes
iety ?etbils i- Category (Optional) Not Categorized
Add a new category to the list
p tran�actinn Next transaction R.el'urn to Accourt Actwll -v
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f<j Back to order details
c�
Payment Summary Date printed Apr -10 -10
Status: Paid with PayPal on Apr 10, 2010.
Seller: sabsumran
Buyer: 142star
Shipping
Seller should ship to: Sara Campbell
9003 Max Ct
Fishers IN 46037 -9053
United States
Payment
Item Name Shipping Qty Price
Nike ACG Wildedge GORE -TEX Hiking Shoes Men US Postal Service Priority Mail: US $13.75 1 US $21.07
Sz 13.280488465894 Estimated delivery April 16 -April 19, 2010
Subtotal: US $21.07
Shipping handling: US $13.75
Total: US $34.82
Payment details: PayPal
elyay yerPr0teCtacr_1 We'll saver your purchase price plus original shipping Learn more
Copyright 1995 -2010 eBay Inc. All Rights Reserved. Designated trademarks and brands are the property of their respective owners. Use of this
Web site constitutes acceptance of the eBay User Agreement and Privacy Policy,
eBay official time
httn• /navmPrrtc Phav cnm /w.c /PRavTCAPT 4/10/201
"111111r, 13d,[IfUllg I IdIISUCLI011 LJCLZill rage i of i
rnibank.com I Help I Sign Off
BANK 00111ne Bank�rlq
6 spc1ire Tran Funds P Bills w Send Money Customer Service Alerts Apply for Products
Account Overview Transaction Detail
Accouni AcVw;iv Here's a summary of your completed transaction. You may add a note or
Online Statements categorize this transaction now. When you're done, click "Save changes."
Download Transactions
Maymne teaorief, Completed On: 04/12/2010
Create a banking report Description: CHECK CARD PURCHASE MERCHANT PURCHASE
TERMINAL 449215 PAYPAL SABSUMPLAN 402 935 7 CA
04-10-10 SEQ 010127849038
Amount: $34.82
Transaction Type: WITHDRAWAL
i 0V M &I
Online Banking
Guarantee Personal Note (Optional): Work Shoes
Category (Optional). Not Categorized
Add a new category to the list
F T
si:.: j-1
Copyright 2010 Marshall Ilsley Corporation. All Rights Reserved. Member FDIC.
C11 A /n(NIA
VIDUCHER 1 01801 WARRANT ALLOWED
T1006 IN SUM OF
CAMPBELL, CLAY
CARMEL UTILITIES
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
u �Q'��
060110 01- 6040 -07
Coq ,lj o1.6a00.07
ciajrpb�
II 2 o o2oD.o� -b
r i� q-
Voucher Total
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995).
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1006
CAMPBELL, CLAY Purchase Order No.
CARMEL UTILITIES Terms
Due Date 5/27/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/27/2010 060110 $542.05
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
v
Date Officer
�5
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print. Submit completed form to Department Head prior to commencement of course.)
Employee Name C, I C, t C
Department 'VJ NJA Z f VAt A C J I &-J) n C�1 SSN Hire Date
Educational Institution*
Name of Course Ct 1 S a v►n
Starting Date of Course (month/day /year) C 1 a 10
By signing below, I signify that I understand the following:
The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -59.
To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy
of my final grade. To receive reimbursement for books, I must submit the book list for the course
and an original itemized receipt for all books purchased.
If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will
repay the City in full for its tuition and book reimbursements for this course.
The tax status of reimbursement payments is sub'ect to federal law, which may change from time to time.
Employee Signature Date 2
Part H (to be completed by Department Head)
(Submit to Human Resources)
By signing below, I certify that the applicant will have been employed full -time by the City for at least one (1)
year prior to the commencement of the course, and has not been subject to a disciplinary.probation, suspension
or demotion within 90 days prior to the beginning of the course. The final claim will be paid from my
department's budget, subject to the terms of Section 2 -59 of Carmel City Code.
Department Head Signature Date 4 1,2
Part III (to be completed by Director of Human Resources)
Final Approval w— �C Date CS
If denied, reason for denial
The tuition reimbursement program covers only full- semester courses offered through a degree granting institution
accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor.
An application will not be considered complete unless a course description from the school's literature is attached.
1�
View My Grades Page 1 of 2
Go to Bottom Student Center
Clay Campbell
Search for Classes Academic Planning My Academics Grades
View My Grades
Spring 2010 1 Undergraduate I IUPUI change term
Class Grades Spring 2010
Official Grades
!Class Description Units Grading Grade Grade
Points
HIST -J 495 PROSEMINAR FOR 3.00 Graded B 9.000
HISTORY MAJORS
Term Statistics Spring 2010
From Cumulative
IUPUI Student Acct Svcs- Bursar
PA Log 1 A 'i PA W C: c
1 PO Box 6020
Account Statement
as a 4 a 9*12 V[1'7
Statement Date: 02/02/10 Page 1 of 1 ue, Date; 02/16/10
Billing Reference: IN BILL# PreJious_Balance: 0.00
University ID: MinimumDue 448.64
Student Name: Campbell,Clay Samuel ?`Total Due. 867.28
Statement notification sent to clscampb @iupui.edu
Charges and Adjustments
01/10/10 Resident Undergraduate Fees 692.28
01/10/10 General Fee 175.00
Total Charges and Adjustments: 867.28
Messages
Paying at least the minimum amount due as indicated will enroll you in the payment plan program. There will be a non refundable service charge
Visit our website at http: /osas.iupui,edu for important information about refunds, how and where to pay, and special announcements concerning
If you have questions about your account statement, please contact Student Account Services Bursar; telephone: 317.274.2451 e-mail:
Effective Aug. 1, 2010 new CREDIT CARD CONVENIENCE FEE for IUPUI (Indianapolis Campus only). For more information, please visit the
Make payment online at http:] /onestart.iu.edu
it mailing payment, include the bottom portion of this statement and make check payable to; INDIANA UNIVERSITY
detach
IUPUI Student Acct Svcs Bursar muniversity ID, 0001963789
PO Box 6020 pue:Dake': 02/16/10
Indianapolis, IN 46206 -6020
Minimum Due 448.64
'Total Due': 867.28
Amount Eggloped,
Campbell,Clay Samuel
9003 Max Ct
Fishers, IN 46037
USA IUPUI Lockbox
Payment Processing Center
PO Box 7245
Indianapolis, IN 46206 -7245
AIUINA0001 96378900000000086728000000000448645
QuikPAY(R) Print Payment Receipt Page 1 of 1
Payment Receipt
This is your receipt.
Your payment has been submitted. Thank you.
Confirmation Number: 6227941
Payment Date: May 14, 2010 at 8:59 PM, EDT
Effective Date: May 17, 2010
Primary User Id: 0001963789
Primary User Name: Clay Campbell
Account: Indianapolis
Payment Amount: $942.28
Cardholder's Name: Sara Campbell
Payment Method:
Address Info 9003 Max Court
Fishers, IN 46037
Contact Info: (317)441-8764 (daytime phone)
Your payment has been received by Indiana University.
https:H quikpayasp. com/ iu/ qp/ epay /preparePrintPaymentReceipt.do 5/14/2010
Payment Summary Page 1 of 1
Back to order details
MLJVT
0
Payment Summary Date printed: Apr -10 -10
x
Status: Paid with PayPal on Apr 10, 2010.
Seller: peseadoe
Buyer: 142star
Shipping
Seller should ship to: Sara Campbell
9003 Max Ct
Fishers IN 46037 -9053
United States
Payment
Item Name Shipping Qty Price
SALOMON GORE -TEX Hiking Boot Shoes Men 13 /US Postal Service Priority Mail: US $10.99 1 US $64.99
48.330413178182 Estimated delivery: April 15 April 16, 2010
Subtotal: US $64.99
Shipping handling: US $10.99
Total: US $75.98
Payment instructions: Please use ebay checkout. Paypal it is easy and safe. Click "PayNow" tab and follow through the
process or go directly to www.paypal.com. Thanks!
Payment details: PayPal
V e$ay Buyer Protection We'll cover your purchase price plus original shipping. Learn more
Copyright 1995 -2010 eBay Inc. All Rights Reserved. Designated trademarks and brands are the property of their respective owners. Use of this
Web site constitutes acceptance of the eBay User Agreement and Privacy Policy.
e8ay official time
W
http:// payments .ebay.com /ws /eBayISAPI.dll ?V iewPaymentStatus &transid 428201305014... 4/10/2010
Online Banking Transaction Detail Page 1 of 1
mibank.com I Help i Sign Off
BANK Online Banking
9 Secure Onllne Session Transfer Funds Pay Bills Send Money Cus tomer Servic Alerts Apply for Products
Account Overview Transaction Detail
Account Activity Here's a summary of your completed transaction. You may add a note or
Online Statements categorize this transaction now. When you're done, click "Save changes."
Download Transactions
Manaqe Categories Completed On: 04/12/2010
Create a banking report Description: CHECK CARD PURCHASE MERCHANT PURCHASE
TERMINAL 449215 PAYPAL CENGKERIK6 6 402 935 7
CA 04 -10 -10 SEQ 010024849036
Amount: $75.98
Transaction Type: WITHDRAWAL
f\ M &I
Online Banking
Guarantee Personal Note (Optional): Work Shoes
>ViewDetails Category (Optional): Not Categorized
Add a new category to the list
Previous transaction Next transaction Return to Account Activity
How do P Glossary FA.Os
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n
Uft I nu
LENDER
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Payment Summary Page 1 of 1
Back to order details
0
Payment Summary Date printed: Apr -10 -10
Status: Paid with PayPal on Apr 10, 2010.
Seller: sabsumran
Buyer: 142star
Shipping
Seller should ship to: Sara Campbell
9003 Max Ct
Fishers IN 46037 -9053
United States
Payment
Item Name Shipping Qty Price
Nike ACG Wildedge GORE -TEX Hiking Shoes Men US Postal Service Priority Mail: US $13.75 1 US $21.07
Sz 13.280488465894 Estimated delivery: April 16 April 19, 2010
Subtotal: US $21.07
Shipping h U
Total: US $34.82
Payment details: PayPal
V eBay Buyer Protection we'll cover your purchase price plus original shipping. Learn more
Copyright 1995 -2010 eBay Inc. All Rights Reserved. Designated trademarks and brands are the property of their respective owners. Use of this
Web site constitutes acceptance of the eBay User Agreement and Privacy Policy.
eBay official time
1�
http: payments .ebay.com /ws /eBayISAPI.dl l ?V iewPaymentStatus &transid= 0 &userloginid... 4/10/2010
Online Banking Transaction Detail Page 1 of 1
mibank.com i Help i Sign Off
BANK Online Banking
Secvre Online Session t'�°'s' I Transfer Funds Pay Bills Send Money Customer Service Alerts Apply for Products
Account Overview Transaction Detail
Account Activity Here's a summary of your completed transaction. You may add a note or
Online Statements categorize this transaction now. When you're done, click "Save changes."
Download Transactions
Manage Cateaories Completed On: 04/12/2010
Create a banking report Description: CHECK CARD PURCHASE MERCHANT PURCHASE
TERMINAL 449215 PAYPAL SABSUMRAN 402 935 7 CA
04 -10 -10 SEQ 010127849038
Amount: $34.82
Transaction Type: WITHDRAWAL
M &I
Online Banking
Guarantee Personal Note (Optional): Work Shoes
View etalls Category (Optional): Not Categorized
Add a new category to the list
-sve Changes cancel
Previous transaction Next transaction Return to Account Activrtv
How do 1') Glossary FAOs
Copyright 2010 Marshall Ilsley Corporation. All Rights Reserved. Member FDIC. Advortisino Disclosures K Site Disclaimers I Your Privary
rx+n ro a
I FNDFR
https:Hcibng. ibanking services. com/ cib/ CEBMainServiet /TransactionDetail 5/14/2010
VOUCHER #-105552 WARRANT ALLOWED
T1005 IN SUM OF
CAMPBELL, CLAY
CARMEL UTILITIES
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
�2od
CAMPBELL2 017W -07 $13.06
001T 0 f."c)K0.07 -3
Voucher Total
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts Ciiy Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T1005
CAMPBELL, CLAY Purchase Order No.
CARMEL UTILITIES Terms
Due Date 5/27/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/27/2010 CAMPBELL $13.06
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with 1C 5- 11- 10 -1.6
Date Officer