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Home My WebLink About186230 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 %,JuAAU rA i kV,) i iuiL r ayiix;_,iiL INAA rlpi i i ui i 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 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 `0 a httn /na vme.ntq_eha. v_ com /ws eRnvTS A PT.r111?V i ewPavment'�tatus &tra.nSid= 4292[71305014... 4/1 0/2010 t1111111V LtLillllllb RASI.lLJI,�V LS Vll. l/1rLUll I Ur,%, L VI 1 mibank.com l Help l Sign off BANK Onlin e, Bill iki g 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 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 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 HO A .In P (ji 5 ary rACs Copyright 2010 Marshall Ilsley Corporation. All Rights Reserved. Member FDIC. gelverrising nip, -!r,- r s c to Di Sclaiwc�r5 Ym!r privacy Tal LENflE!? 11tnS /nihnsT- ihan�Cinc7- cPtvir.w.e r. nm/ rih/( ?F. RMainCPre ,1Pt /Tranea�tinnTlwtail S /ld /7 (11 f1 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 Copyright 2010 Marshall Ilsley Corporation. All Rights Reserved. Member FDIC. Advertisino Disclosures Site Disclaimers I Your Privacv n Uft I nu LENDER https: /cibng.ibanking- services. com/ cib/ CEBMainServlet/TransactionDetail 5/14/2010 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