HomeMy WebLinkAbout194970 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 359016 Page 1 of 1
ONE CIVIC SQUARE KAREN BREEDLOVE
CARMEL, INDIANA 46032 16579 LAKEVILLE CROSSING CHECK AMOUNT: $30.00
WESTFIELD IN 46074
CHECK NUMBER: 194970
CHECK DATE: 3/2/2011
DEPARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 30.00 EMPLOYEE PEN BENEFI
Page 1 of 1.
PNC Online Banking
Date Description.!. Amount Account
01/12/2011 Check 1276 $30.00 4618890277
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Indiana Backfiow Prevention Association Backt7ow Workshop
Registration Form
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on m embers works admission,cost automatically include a one ye-,V members up in the National ABPA and IB
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Please select your membership status: ABPA MEMBER NON MEMBER OF ABPA
Title:
Company
Name: Address:
g� AaA�aKo Cit
S tate: \a Zip/Postal
Code Y U Work phone :(50 Fax
:(3 I) M E-mail
address:
ABPA Member Registration $34 ABPA Non-Member Registration $115
Total Amount Paid: SO (remit US drawn on a US bank, payable to the IBPA)
If paying by credit card include the following and fax to 317-867-2667
Credit Card No.: Expiration Date:
Name as it appears on the card:
Signatur L dK_Q_W
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ABPA no -members: This form also serves as your ABPA MEMBERSHIP APPLICATION.
Membership in the Indiana Backflow Prevention Association constitutes paying national dues
www.abvaindiana.org
Please make checks payable to: IBPA
IBPA Address: 2313 W. SR32 Yulfield IN. 46074
Contact Information: Office 317-867-3398 Fax 317-867-2667
ABPA Federal ID 74-2395100
Visit our Website www.abpaindiana.orgy
VOUCHER 104193 WARRANT ALLOWED
T5962 p W4r IN SUM OF
BREEDLOVE, MICHELLE EW 77ON
CARMEL WATER DISTRIBUTION
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1276 01- 6040 -05 $30.00
Voucher Total $30.00
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
T5962
BREEDLOVE, MICHELLE Purchase Order No.
CARMEL WATER DISTRIBUTION Terms
Due Date 1/18/2000
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/18/2000 1276 $30.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer