HomeMy WebLinkAbout194625 02/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00350029 Page 1 of 1
ONE CIVIC SQUARE ILMCT
CARMEL, INDIANA 46032 C/O TERESA GLEN CHECK AMOUNT: $185.00
PO BOX 607
CHECK NUMBER: 194625
GREENCASTLEIN 46135
CHECK DATE: 2/16/2011
DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355300 185.00 ORGANIZATION MEMBER
ILMCT ANNUAL DUES NOTICE
Claim and Invoice
This invoice and claim for payment is made upon the Clerk, Controller 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 for any classes of membership. Please check the appropriate box to indicate the actual class
of membership and dues schedule which applies.
2011 Dues for all Classes of Membership due on or before March 1, 2011!
Active Members:
Towns with population under 700 40.00
Towns or Cities with population of 701 to 5,000 50.00
Towns or Cities with population of 5,001 to 20,000 75.00
Towns or Cities with population over 20,001 to 35,000 $100.00
Towns or Cities with population over 35,000 $150.00
Please indicate your municipality population
Active Member Name:
Title: Ierk- Treasurer Clerk Controller
Certification (Check all that apply): IA CMC MMCA MMC CMFA
Name of Municipality: l.f�'fl �f County
Office Address:
City/Town /Zip: Y60
Office Phone: ((C Zifro� Fax: 7
Office e -mail: Ot Co rJ r
Home Address: City/Town /Zip:
Home Phone:
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.org
Associate Members: $35.00
(Any former active member or staff of an active member of the league):
Associate Member Name: [Yid Title. u G
Address: City /Town /Zip: �Y
Associate Member Name: Title:
Address: City /Town /Zip:
(Please copy form for additional Associate Members)
Affiliate Members:
(Any person who is elected or an appointed officer in municipal government who is not already qualified for
another membership class may ;njoyall p�g�s, except the right to vote and hold office.)
Affiliate Member Name: Title: UK
Address: City/Town /Zip:
Affiliate 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-mail:
Address (if different from above)
TOTAL ACTIVE MEMBER: Checks to be made payable to the
TOTAL ASSOCIATE MEMBER Indiana League of Municipal Clerks
TOTAL AFFLIATE MEMBER Treas s and mailed to:
TOTAL ASSOCIATE BUSINESS MEMBER ILMCT c/o Teresa Glenn
l P.O. Box 607
TOTAL AMOUNT ENCLOSED Greencastle, IN 46135
I hereby certify that the foregoing is just and correct, that the amount claimed ally due after allowi
just credits and that no part of the same has been paid.
.J7e&,eja J C&i, Treasurer
PLEASE RETURN A COPY OF THIS INVOICEICLAIM WITH YOUR 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
Purchase Order No.
0 1 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.
C� J ALLOWED 20
V J IN SUM OF
M Liz
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE 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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund