The URL can be used to link to this page

199965 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 353566 Page 1 of 1 ONE CIVIC SQUARE I A L E I A CARMEL, INDIANA 46032 PO BOX 13857 CHECK AMOUNT: $100.00 RICHMOND VA 23225 CHECK NUMBER: 199965 CHECK DATE: 813/2011 DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION 1110 4355300 100.00 ORGANIZATION MEMBER Professional Certification Program Basic Level Classification Application Basic Level Classification Is Not a Certified Analysts Level but Does Enroll you in the ,Professional Certification Program Use additional sheets of 8 by 11 paper, if necessary, to respond in full to each question. Incomplete applications will be returned. I. Name: i4 &E L ©A- nl (First) l (Middle) (Last) 2. Address: (home) 9 W,4 Telephone: 7 3-7 9 919 Fax: -Mail: M e dDa A Sb m. loba 1, /V (Agency name) `'ej��C- p C %/UIE (Agency Address) mile McC, Telephone: 3/7- 57 S -?-Fax: /7 57/ E -Mail: M dDan@ ea irMel. tr. jbv 3. IALEIA Membership No.: /09d, Yrs. member 4. Work Title: jA)VCS /(j/¢7 /DA14 r4'b M //yIj7,e_,97Dr� (Attach Job Description) 5. Supervisor's Name /Title: Le n/,4►� Telephone No.: 31 57/ a S a a 6. 40 Hour Basic Intelligence Course: Date Taken 3 �S 4 -i /9 A) 7 A V,4eA/ SIS 4 D *Append a copy of Certificate or Diploma Received for Training. 7. Applicant's Certification I hereby certify that all of the above information is true and complete and that I understand that basic level classification is not a certified analyst level but does enroll me in the Professional Certification Program. (Applicant's Signature and Date) 8. PCP Committee Member Review (For IALEIA/PCP Use Only) Certification Number: Certificate Mailed Date: Re- certification Tickler Date: 9. Attach Fee Here or Fill out Credit Card Information: Make checks payable to IALEIA: Basic Level Classification Fee: $50 U.S (Non -US checks must be on banks with US correspondent banks) Visa MasterCard American Express Name on Card: Expiration Date: 1 1 (NOTE: No other cards accepted) Approved by the IALEIA Board. 0410112010 VOUCHER NO, WARRANT NO. ALLOWED 20 IALEIA, Inc. IN SUM OF P.O. Box 13857 Richmond, VA 23225 $100.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1110 43- 553.00 $100.00 I hereby certify that the attached invoice(s), or I I bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thursday, July 28, 2011 Chief of Police Title Cost distribution ledger classification if claim paid motor 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 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)) 07/27/11 payment for membership renewal $100.00 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