189380 08/31/2010DEPARTMENT
CITY OF CARMEL, INDIANA
ONE CIVIC SQUARE
CARMEL, INDIANA 46032
VENDOR: 364670
BRIAN HUTCHISON
24220 LACY RD
CICERO IN 46034
ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
Page 1 of 1
CHECK AMOUNT: $1,454.78
CHECK NUMBER: 189380
CHECK DATE: 8/31/2010
1120 4128000 1,454.78 TUITION REIMBURSEMENT
COLLEGEWIDE COURSE OUTLINE OF RECORD
CHEM 101, INTRODUCTORY CHEMISTRY I
COURSE TITLE: Introductory Chemistry I
COURSE NUMBER: CHEM 101
PREREQUISITES: Demonstrated competency through appropriate assessment or earning a
grade of "C" or better in ENGL 025 Introduction to College Writing .II and ENGL 032 Reading
Strategies for College II and MATH 015 Fundamentals of Algebra I or MATH 023 Essentials of
Algebra I or MATH 050 Basic Algebra and
SCHOOL: Liberal Arts and Sciences
PROGRAM: Liberal Arts
CREDIT HOURS: 3
CONTACT .HOURS: Lecture: 2 Lab: 2
DATE OF LAST REVISION: Fall, 2009
EFFECTIVE DATE OF THIS REVISION: Summer, 2010
CATALOG DESCRIPTION: An introductory course that includes the science of chemistry and
measurement, atomic theory and the periodic table, chemical bonding, equation writing and
balancing, stoichiometry, and gases.
MAJOR COURSE LEARNING OBJECTIVES: Upon successful completion of this course the
student will be expected to:
1. Measure with S.I. (Systeme Internationale) and U.S.C.S. (U.S. Customary System) units of
length, volume and mass.
2. Perform mathematical calculations using scientific notation.
3. Distinguish between accuracy and precision of measurement.
4. Solve mathematical problems using dimensional analysis.
5. Differentiate among electrons, protons, and neutrons and describe how they affect the
properties of elements.
6. Explain the differences between the common states of matter in terms of visible properties
and particle movement.
7. Distinguish between elements, compounds, homogeneous mixtures and heterogeneous
mixtures.
8. Describe the periodic table in terms of element arrangement in periods, groups, and subshell
blocks.
9. Describe modern atomic theory.
10. Describe the electron configurations of elements, determine the number of valence electrons
for all representative elements, write Lewis Structures for the representative elements and
simple compounds.
11. Distinguish between ionic and covalent bonding.
12. Describe the different types of intermolecular forces.
13. Given the name (or formula) of a compound, write the formula (or name) of that compound.
Ivv Tech Community College 1 CHEM 101
Academic Affairs
14. Given the mass (or moles) of an element or compound, calculate the moles (or mass) of that
element or compound.
15. Calculate the concentration of a solution in terms of percent and molarity.
16. Classify chemical reactions into one of the three major groups (synthesis, oxidation
reduction, and exchange).
17. Balance a chemical equation by inspection.
18. Describe the properties of acids, bases, and salt.
19. Determine simple pH and pOH.
20. Calculate mass relationships in chemical reactions by using stoichiometry.
21. Calculate the change in pressure, volume, or temperature of a gas using the appropriate gas
law.
22. Use common types of chemical glassware, equipment, and chemicals safely and
appropriately.
23. Describe and illustrate chemical principles in laboratory situations.
24. Obtain reproducible data from chemical experiments; analyze, interpret, and communicate
the data in a logical and coherent manner.
25. Recognize uncertainties in data and identify potential sources of error.
COURSE CONTENT: Topical areas of study include
Introduction to chemistry
Measurements and calculations
Matter and energy
Chemical foundations I: Elements, atoms,
and ions
Nomenclature
Chemical reactions: Introduction
Chemical reactions: Classification
Chemical reactions: In aqueous solutions
Topical areas of study to be included in the laboratory
Chemical safety
SI measurements
Families of elements
Stoichiometry
Chemical reactions
Use of chemistry glassware equipment
ACADEMIC HONESTY STATEMENT:
pH and pOH
Introduction to acids and bases
Chemical compositions
Chemical quantities
Chemical foundations II: Modern
atomic theory
Chemical bonding
Stoichiometry
Gases
Physical properties
Chemical properties
Acids and bases
Empirical formulas
Gas laws
Chemical bonding
The College is committed to academic integrity in all its practices. The faculty value
intellectual integrity and a high standard of academic conduct. Activities that violate
academic integrity undermine the quality and diminish the value of educational achievement.
Iw Tech Community College 2 CHEM 101
Academic Affairs
Cheating on papers, tests or other academic works is a violation of College rules. No student
shall engage in behavior that, in the judgment of the instructor of the class, may be construed
as cheating. This may include, but is not limited to, plagiarism or other forms of academic
dishonesty such as the acquisition without permission of tests or other academic materials
and /or distribution of these materials and other academic work. This includes students who
aid and abet as well as those who attempt such behavior.
COPYRIGHT STATEMENT:
Students shall adhere to the laws governing the use of copyrighted materials. They must
insure that their activities comply with fair use and in no way infringe on the copyright or
other proprietary rights of others and that the materials used and developed at Ivy Tech
Community College contain nothing unlawful, unethical, or libelous and do not constitute
any violation of any right of privacy.
ADA STATEMENT:
Ivy Tech Community College seeks to provide reasonable accommodations for qualified
individuals with documented disabilities. If you need an accommodation because of a
documented disability, please contact the Office of Disability Support Services.
If you will require assistance during an emergency evacuation, notify your instructor
immediately. Look for evacuation procedures posted in your classroom.
Ivy Tech Community College 3 CHEM 101
Academic Affairs
COLLEGE WIDE COURSE OUTLINE OF RECORD
COMM 101, FUNDAMENTALS OF PUBLIC SPEAKING
COURSE TITLE: Fundamentals of Public Speaking
COURSE NUMBER: COMM 101
PREREQUISITES: Demonstrated competency through appropriate assessment or earning a
grade of "C" or better in ENGL 025 Introduction to College Writing 11, and ENGL 032 Reading
Strategies for College II
SCHOOL: Liberal Arts and Sciences
PROGRAM: Liberal Arts
CREDIT HOURS: 3
CONTACT HOURS: Lecture: 3
DATE OF LAST REVISION: Spring, 2007
EFFECTIVE DATE OF THIS REVISION: Fall, 2008
CATALOG DESCRIPTION: Introduces fundamental concepts and skills for effective public
speaking, including audience analysis, outlining, research, delivery, critical listening and
evaluation, presentational aids, and use of appropriate technology.
MAJOR COURSE LEARNING OBJECTIVES: Upon successful completion of this course the
student will be expected to:
1. Analyze an audience and adapt presentations accordingly.
2. Apply principles of composition to the development of oral presentations, such as
effective organization and outlining.
3. Develop ideas with credible forms of support and appropriate documentation.
4. Recognize and demonstrate nonverbal communication appropriate to the verbal message.
5. Use presentational aids to support and enhance oral presentations.
6. Actively listen to and critically evaluate oral presentations.
7. Apply the fundamental concepts of effective public speaking through oral presentations.
8. Incorporate appropriate technology to support and enhance oral presentations.
COURSE CONTENT: Topical areas of study include
Communication models elements
Listening
Analyzing the audience and assessing
the situation
Using presentational aids
Organizing the body of speech
Outlining the speech
Speaking to inform
Speaking to persuade
Common fallacies
Ethics and public speaking
Selecting a topic and purpose
Researching the speech topic
Supporting materials and tests of evidence
Speech introductions and conclusions
Oral and written source citation
Presenting the speech language and
delivery modes
Using technology
Ivy Tech Community College 1 COMM 101
Academic Affairs
ACADEMIC HONESTY STATEMENT:
The College is committed to academic integrity in all its practices. The faculty value intellectual
integrity and a high standard of academic conduct. Activities that violate academic integrity
undermine the quality and diminish the value of educational achievement.
Cheating on papers, tests or other academic works is a violation of College rules. No student
shall engage in behavior that, in the judgment of the instructor of the class, may be construed as
cheating. This may include, but is not limited to, plagiarism or other forms of academic
dishonesty such as the acquisition without permission of tests or other academic materials and/or
distribution of these materials and other academic work. This includes students who aid and abet
as well as those who attempt such behavior.
COPYRIGHT STATEMENT:
Students shall adhere to the laws governing the use of copyrighted materials. They must insure
that their activities comply with fair use and in no way infringe on the copyright or other
proprietary rights of others and that the materials used and developed at Ivy Tech Community
College contain nothing unlawful, unethical, or libelous and do not constitute any violation of
any right of privacy.
ADA STATEMENT:
Ivy Tech Community College seeks to provide reasonable accommodations for qualified
individuals with documented disabilities. If you need an accommodation because of a
documented disability, please contact the Office of Disability Support Services.
If you will require assistance during an emergency evacuation, notify your instructor
immediately. Look for evacuation procedures posted in your classroom.
Ivy Tech Community College 2 COMM 101
Academic Affairs
04/19/2010 15:30 3175714244
Part I (to be completed by employee)
(please print. Submit completed form to Department Had prior to commencement of course.)
Employee Name
Department C
icy•
t
City Of Carmel
Tuition Reimbursement Application Form
1=i
triq
CARMEL FIRE DEPARTMT PAGE 01
SsN Hire D,ste 4 "J.J2ootb
Educational InstiU.ion* .Lvy TeLk f omr or611. �atltn°
Name of Course Enc, )rt _CO pd"�1Z^1
m y
Starting Date of Course (ontb/day/year) 6J3J2.0t0
13y signing below, 1 signify that 1 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, Y must submit the book list for the course
and an original itemized receipt for all books purchased.
o 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 fr om time to time.
Date 41a 1_1610
Employee Signature
Part II (to be completed by Department Mead)
(Submit to Human Resources)
By signing below, I certify that the applicant will have been employed full -time by the City for at lust one (I)
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
departrneut's budget, subject to the teens o Lion 2 -59 of C City Code.
Department Head Signature
Final Approval
If denied, reason for denial
Part ICI (to be completed by Director of Bump Resources)
Date S
i 'Mc tuition reiinnburmement pro covers only thll -semen er courses offered ebrough a degree-granting institution
accredited by the North Centel Association of Colleges and Schook or an equivalent regional =creditor.
Ate application will not be considered comply unless a course deuctiOtion from the school's like is attached.
Ry a7
COLLEGEWIDE COURSE OUTLINE OF RECORD
ENGL 111, ENGLISH COMPOSITION
COURSE TITLE: English Composition
COURSE NUMBER: ENGL 111
PREREQUISITES: Demonstrated competency through appropriate assessment or
earning a grade of "C" or better in ENGL 025 Introduction to College Writing I and
ENGL 032 Reading Strategies for College II
SCHOOL: Liberal Arts and Sciences
PROGRAM: Liberal Arts
CREDIT HOURS: 3
CONTACT HOURS: Lecture: 3
DATE OF LAST REVISION: Spring, 2009
EFFECTIVE DATE OF THIS REVISION: Fall, 2009
CATALOG DESCRIPTION: English Composition is designed to develop students'
abilities to think, organize, and express their ideas clearly and effectively in writing. This
course incorporates reading, research, and critical thinking. Emphasis is placed on the
various forms of expository writing such as process, description, narration, comparison,
analysis, persuasion, and argumentation. A research paper is required. Numerous in -class
writing activities are required in addition to extended essays written outside of class.
MAJOR COURSE LEARNING OBJECTIVES: Upon successful completion of this
course the student will be expected to:
1. Understand communication theory and the roles audiences play in the writing
process.
2. Apply critical reading and thinking skills to the writing process.
3. Demonstrate an awareness of language as a tool for learning and communication.
4. Develop strategies for making independent, critical evaluations of student and
published texts.
5. Research and critically evaluate information to produce writing with APA or
MLA for`ma1 documentation, which consists of in -text citations and final list of all
sources cited.
6. Apply strategies for the composition process such as drafting, collaboration,
revision, and peer evaluation to produce written documents.
7. Write well organized essays with a firm thesis and a clear introduction, body, and
conclusion.
8. Engage in pre writing activities, including narrowing a topic, generating ideas,
determining the audience and the relationship between audience and content, and
setting an appropriate tone.
9. Demonstrate an understanding of the various rhetorical modes, including
argumentation and analysis, and apply that understanding in various writing
environments, including an essay test.
Ivy Tech Community College 1 ENGL 111
Academic Affairs
10. Support a thesis statement with valid reasons and evidence.
I l Follow the conventions of standard written English, in sentence structure,
punctuation, grammar and usage, and spelling.
12. Recognize and develop styles appropriate to varied writing situations.
COURSE CONTENT: Topical areas of study will include
Reading and thinking critically
Generating ideas
Identifying an audience
Developing a thesis
Organizing the essay
Using rhetorical modes including
exposition, argumentation and
analysis
Pre- writing, drafting, editing, and
revising
Conducting library and other research
methods
Following conventions of standard
written English
Writing essay exams
Gathering, evaluating, and using sources
for research
Paraphrasing, summarizing, and quoting
Documenting sources (MLA and /or
APA)
Developing style
Avoiding plagiarism
HOW TO ACCESS THE IVY TECH COMMUNITY COLLEGE VIRTUAL
LIBRARY:
The Ivy Tech Virtual Library is available to students on- and off campus, offering full
text journals and books and other resources essential for course assignments. Go to
http: /w /library and choose the link for your campus.
METHODS OF EVALUATION:
Grading procedures will be established by the instructor and will be clarified at the first
class session. Students will write for evaluation at least five compositions and an essay
exam. Students will write a minimum of 5,000 words excluding rough drafts during the
semester. At least two compositions must include analysis and argumentation.
Instructors will require that in at least one paper students will incorporate outside sources
into their writing and use an appropriate style of documentation.
ACADEMIC HONESTY STATEMENT:
The College is committed to academic integrity in all its practices. The faculty value
intellectual integrity and a high standard of academic conduct. Activities that violate
academic integrity undermine the quality and diminish the value of educational
achievement.
Ivy Tech Community College 2 ENGL 111
Academic Affairs
Cheating on papers, tests or other academic works is a violation of College rules. No
student shall engage in behavior that, in the judgment of the instructor of the class, may
be construed as cheating. This may include, but is not limited to, plagiarism or other
forms of academic dishonesty such as the acquisition without permission of tests or
other academic materials and/or distribution of these materials and other academic
work. This includes students who aid and abet as well as those who attempt such
behavior.
COPYRIGHT STATEMENT:
Students shall adhere to the laws governing the use of copyrighted materials. They must
insure that their activities comply with fair use and in no way infringe on the copyright
or other proprietary rights of others and that the materials used and developed at Ivy
Tech Community College contain nothing unlawful, unethical, or libelous and do not
constitute any violation of any right of privacy.
ADA STATEMENT:
Ivy Tech Community College seeks to provide reasonable accommodations for qualified
individuals with documented disabilities. if you need an accommodation because of a
documented disability, please contact the Office of Disability Support Services.
If you will require assistance during an emergency evacuation, notify your instructor
immediately. Look for evacuation procedures posted in your classroom.
Ivy Tech Community College 3 ENGL 1.11
Academic Affairs
04/19/2010 15:32 3175714244
Part d (to be co pleted by employee)
(Please print. Submit completed form to Department Head 1T,.k commencement of course.)
Employee Name (N
Department ar r'ltl I rf.
City Of Carmel
Tuition Reimbursement Application Form
Name of Course" u.
CARM'EL FIRE DEPARTMT PAGE 61
Hi D 4 Ith
Educational Institution* Sys Tech teawitorai f lk L
Starting Data of Course (montb/daylyear) ghl2ta
By signing below, I signify that I ondetstand the following:
O 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 far 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 dirt for all books puechased-
a If I leave City of Carmel employment sooner than one (1) year after the end of this °nurse, I will
may 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.
Date I1J2D
Employee Signature
Department .Bead Signature
Bel tenee7
wad)
Part 11 (to be complete by Department
(Submit to Haman Resotnces)
By signing below, .I certify that the applicant will have been employed fall by the City for at least one (1)
year prior to the commencement of the coon e, and bas 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 2 -590 I el. City Code.
Date
17
Port I (t he completed by 'rector of etman Resources)
Final Koval
If denied, reason for denial
,oa133 s o
The tuition sehuhursement prow= covers only full- sentestr courses offered through a degree-graating institution
accredited by the No rth Cermal Assatiatian of Collets and &cools ortm Naivalent regional sottyditer.
An application will not be considered compere unless a course description hour the school's literature is attached.
04/19/2010 15:28 3175714244
City Of Carmel
Tuition Reimbursement Application Form
Part I (to be completed by employee)
(Please print. Submit completed form to Department Head prior to conuueneement of course.)
Employee Name 6 f icon I CJ 1► Scr
Department 6 trvie Fi{' Ii p SSN kare Date gl/42_ x
national bastitutioo* Tech Lerntnori %ks Lollec .f.
Name of Coutse'"t1'o6orial, (..►t t't
Starting Date of Course (ntonth/day/year) Qb /Si '0%0
13y signing below,1 signify that 1 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 roust 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 Cannel 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 reimbursenent ymen is subject to federal law, which may change from time to time.
Employee Signature
Department Bead Signature
Part II (to be completed by IDepar fead)
(Submit to Human Resources)
CARMEL FIRE DEPARTMT PAGE 01
By signing below, 1 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 iuy
department's budget, subject to the term Sectio4 -5 f CazmeI City Code.
Part 111 (to be completed by Director of Human Resources)
Final Approval Date S/3 Ji 6
if denied, reason for denial
The tuition rein bwssca nc nd reognim covets only full tester manses offered though a dig iustitution
accrecrued by the North Cc d ral Asmciatioa of Colleges and Schools or an equivalent regional ac nr.
An app1ieation will not be considered cotoptetc unless a course description from the school's literature is attached,.
Paymentknteip:
important Information
Home eBills
ham.fjpguettivylect. eduferd...elwelvtarne
T:hac,kk irOu for your paivrrent Ube ioAl! soe yo a c.onftrrnabon e-rni:04
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Payment Conformation
Payment Date: Tuesday, May 11, 21311:1
Payment Time: 0127111 FM EDT
Name of Payee: ivy Tech Community Coitege
Name on Bank Account: Brian P. Hutchison
Bank Account Type:
Depository: M N 1 MARSHALL it.SLEY BANK
4701 W SCHROEDER DR
BROWN DEER,N1 53223
Amount Paid: 3 1,060.95
Student Name: Brian P. Hutch:sun
Confirmation Number: 90E.
Please print this page for your records,
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Questions; call. 317.921.A800
Date:
05/03/20
Student ID:
Term: Summer 2010
Due Date. 23- MAY -2p10
Check Number.
FINANCIAIAID S-T tes
Fi nancial AId p si r es
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remember to include your Student ID
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If paying by check
Packing Slip
Store: 1076 IVY TECH CC DISTANCE LEARNING
Order Information
Web Number: 10760000124889
SODA Number: 4248693 -001
Customer Name: Brian Hutchison
Order Date: 06/04/2010 12:13 PM
Last Updated: 06/04/2010 02:17 PM
Home Phone: (317) 727 -3978
Customer Email: bh6304 @yn&ail.com
Substitute Preference: Yes Please substitute,
Product
Intro to Gen Org Biochemistr
y (SSM)
South Bend Campus>CHEM >101 >16R
Chemistry Lab Simulations (Acc <New> 10805163
ess Code) NON RETURNABLE
South Bend Campus>CHEM >101 >16R
Intro to Gen Org Biochemistr
y
South Bend Campus>CHEM >101 >16R
IVY TECH CC DISTANCE LEARNING
RETURNS
II/II/IIIIIIIII
Shipping Information
Shipping Method: FEXGRD
Shipping Address:
Brian Hutchison
24220 Lacy Rd
Cicero, IN 46034 USA
SKU Avail.
Date
<New> 9780495391197 06/09/10
<Used> 9780495391128 06/09/10
End of Packing Document
Qty
1
Page:
Unit
Price
92.50
06/09/10 1 57.25
Subtotal:
Sales Tax:
Shipping:
Order Total (USD):
SHIPMENTS
Total
Price
92.50
1 164.25 164.25
314.00
23.18
16.95
354.13
III IIIIVIIVIU RNIIII III I 1II1ll1I I
=004=4869300101076
57.25
LAWRENCE CAMPUS BKS
FAIRBANKS CTR FOR HEALTH PROF
9301 E 59TH STREET
317-921-4693
w#N.1v '9Ch.bkSt[.cOm
1067mQrafhpo.f0118tf.CD0
ITEM OTY PRICE TOTAL
New
ENG 111 SYLLABUS 2009/2010
012044040 1 $7.50 $7.50T
Used
Concise MCgrdM Hill Pkg
012142278 1 $74.25 $74.25T
Used
PUBLIC SPEAKING:THE EVOLVING A
012080005 1 $67.50 $67.50T
Items Purchased: 3
Items Returned: 0
A3GOciat8:Ki0
Sub Total 149.25
Tax 10.45
Total $159.70
159.70
RETURNS ACCEPTED 7 DAYS AFTER
CLASS START DATE. RECEIPT
REQUIRED FOR ALL RETURNS.
Final Grades
Final Grades
Student Information
Current Program
Associate of Applied Science
Level:
Program:
Admit Term:
Admit Type:
Catalog Term:
College:
Campus:
Major:
Major Concentration:
Academic Standing:
Undergraduate
Indianapolis Public Safety AAS
Summer 2010
Readmit
Summer 2010
Ivy Tech
Indianapolis
Public Safety
Fire Science
Good Standing
Undergraduate Course work
CRN Subject Course Section Course Title Campus Final
Grade
18518 CHEM 101 16R Introductory South Bend A
Chemistry I South
Bend
12102 COMM 101 CVH Fundamentals of Indianapolis A
Public Speaking
12088 ENGL 111 CWH English Indianapolis B
Composition
Undergraduate Summary
Attempted Earned GPA Hours Quality Points GPA
Current Term: 9.000 9.000 9.000 33.00 3.667
Cumulative: 81.500 78.500 78.500 269.00 3.427
Transfer: 0.000 0.000 0.000 0.00 0.000
Overall: 81.500 78.500 78.500 269.00 3.427
Select another Term
RELEASE: 7.3.3.1
httr.c• //hannrrul_cch itnvtarh Prin /nlc/PRlil/hwsknurd.P Viewf Yrde
Page 1 of 1
Brian P. Hutchison
Summer 2010
Aug 16, 2010 03:42 pm
Attempted Earned GPA Quality
Hours Points
3.000 3.000 3.000 12.00
3.000 3.000 3.000 12.00
3.000 3.000 3.000 9.00
8/16/2010
PO# Dept.
INVOICE NO.
ACCT #!TITLE
AMOUNT
1120
41- 280.00
$159.70
1120
41- 280.00
$354.13
1120
41- 280.00
$1
o.9b
VOUCHER NO. WARRANT NO.
Brian Hutchison
FD Employee
$1,574.713
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
Cost distribution ledger classification if
claim paid motor vehicle highway fund
ALLOWED 20
IN SUM OF
Board Members
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
AUG 30 2010 d
Fire Chief
Title
Prescribed by State Board of Accounts
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
City Form No. 201 (Rev. 1995)
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
Invoice
Number
Purchase Order No.
Terms
Date Due
Description
(or note attached invoice(s) or bill(s))
Invoice
Date
20
Clerk- Treasurer
Amount
$159.70
$354.13
$1,060.95
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