HomeMy WebLinkAbout157890 04/01/2008 ="q. CITY OF CARMEL, INDIANA VENDOR: 061600 Page 1 of 1
ONE CIVIC SQUARE LARRY J COLLINS
sR CARMEL, INDIANA 46032
CHECK NUMBER: 157890
CHECK DATE: 411/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DE
1110 4128000 1,980.00 TUITION REIMBURSEMENT
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RECEIPT DATE N o. 76
RECEIVED FROM
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ADDRESS
DOLLARS
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FOR AL 10 3
ACCOUNT HOW PAID
AMT. OF CASH
ACCOUNT
AMT. PAID CHECK
BALANCE DUE MONEY ORDER BY
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0014 W C ON S I N
Indianapolis Center
11350 N Meridian Street, Suite 200
Carmel, IN 46032
INV ®ICE
Date: March 17, 2008
Larry Collins
This letter is to confirm that the following student took classes at Concordia
University Wisconsin Indianapolis Center.
Name Class Date Tuition Grade
Cost
Larry Collins AL103 Music 1/10/08 1/31/08 990.00 A
AL201 English 2/20/08 3/12/08 990.00 A
Language
IP =In Progress
Please feel free to contact me at: 317 844 -1711 if you have any questions. Thank you.
Sincerely,
Priscilla N. Cr ble
Admission Officer
Concordia University Wisconsin Indianapolis Center
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AUTHORIZATIOIN FORM
STUDENT NAME: 2/; Ll vcc.r.JJ
ADDRESS:
CITY: STATE: iti) ZIP -/G y 3
HOME PHONE: WORK EXT.
STUDENT ID �I �g 7
I authorize Concordia University Wisconsin to charge my account:
.9
AMOUNT: .I, 41 a FOR APPLICATION FEE:
REGISTRATION FEE:
MODULE TITLE: Ac /o-3 music 5 A C .20 4l 4t. Jl
TELECOURSE TITLE:
VISA: MASTERCARD: S qll 3 y3 1 43 .2 y rr
CARD EXPIRATION DATE: �d o
t_om Cd U 5
CARD HOLDER NAME (IF DIFFERENT FROM STUDENT)
DATE: 3 SIGNATURE:
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Larry Collins Purchase Order No.
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/26/08, reimbursement for tuition 1,980.00
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.
ALLOWED 20
Larry Collins IN SUM OF
1.980.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 280 1,980.00 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
M?rch 26 20 0S
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund