190193 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 362114 Page 1 of 1
d ONE CIVIC SQUARE KIP BENBOW
CARMEL, INDIANA 46032 10243 CUMBERLAND POINTE BLVD CHECK AMOUNT: $260.00
NOBLESVILLE IN 46060
CHECK NUMBER: 190193
CHECK DATE: 9/2912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4357004 260.00 EXTERNAL INSTRUCT FEE
Application Payment Receipt Page 1 of 1
Close
The National Registry
Of
Emergency
Medical
Technicians® unwcaaie
Paramedic Application Payment Receipt
Today's Date: 8/18/2010 10:32:00 AM
Application: 2010135971
Applicant:
Kip Benbow
10243 Cumberland Pointe Blvd
Noblesville IN, 46060
Application Level: Paramedic
Amount Paid: $110.00
Payment Date: 8/10/2010 2:13:28 PM
Payment Method: Credit Card
Transaction Code: VXHA5DDA811 D
https:// www. nremt. org/ nremt/ CbtEmtServices /cbtPrintAppRcpt.asp ?Appld- 2010135971 8/18/2010
Community Health. Network Invoice
EMS Education
m' tz y 1500 N_ Ritter, Building #3 Suite #3 Date Invoice
Indianapolis, IN 46219
8/16/2010 2014 -25
Bill To
new
P.O. Number Terms
Quantity Item Code Description Price Each Amount
I Paramedic Practical 150.00 150.00
Payment Must be rmide in ash or Money Order made out to
Terri Hamilton
o aQa �614�n
Please make checks payable to:
Community Health Network Totaa $150.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
Kip Benbow
IN SUM OF
$260.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 43- 570.04 $260.00 1 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
S
11 �7
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 221 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Written Test and Practical Fee for Paramedic Certification $260.00
1 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