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HomeMy WebLinkAbout159546 05/14/2008 i CITY OF CARMEL, INDIANA VENDOR: 360624 Page 1 of 1 ONE CIVIC SQUARE TESS PINTER s CARMEL, INDIANA 46032 4683 GRAND HAVEN LANE, APT H CHECK AMOUNT: $369.55 INDIANAPOLIS IN 46280 CHECK NUMBER: 159546 CHECK DATE: 5/14/2008 DEPA ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION 1047 4343000 289.55 TRAVEL FEES EXPENSE 1047 4355300 80.00 ORGANIZATION MEMBER 4 Carmel 6 clay Parks &Recreation Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense Jmvel rePS-+ a 1 U `6 3-13 0� Expense5 3 A'- KS v o All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: Employeen Name (print) ���:C'EIVED APR 2 2 2008 Check Address L L1 payable to: City, St, Zip `M_ Signature: Approved Date: I Date. Business Services Division, Revised 3 -2 -07 FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request a Carmel o Clay Parks &Recreatioen Employee Expense Reimbursement Request Date of Fund Account Account Receipt Vendor listed on receipt Line Budget Description Amount Purpose of Expense 300.0 .N It'I� wi sh{ �—>h D Ssoc.iafi'or� 3 Za OS 30 0 000, OG c V 4 5 Yk 2 q fNN'l receipts should be attached in the same order as listed above. o 1 sales tax will be reimbursed. TOTAL: Employeen Name (print) APR 2 2 2008 Address L AA"� Cor<ana "WfCi Lt1 N BY: Check c payable to: City, St, Zip Signature: `),p,a,�� '�i.��p Approv Date: Date: Business Services Division, Revised 3 -2 -07 FILE: Shared\Administrative \Forms \Staff Forms \Employee Exp Reimb Request Carmel Clay Parks &Recreation CHECK REQUEST Date: 7_11 1 RECEIVED FEB 2 2008 Check payable to BY Name: Address: FCt�'_ City, State, Zip 0 -M KU`, KA `46 (2)'�,L Check Amount: M ©;O Date Required: i Mail to payee Deliver to staff member making this request Check needed for: k6 (Yl C l D nk e'n u Tee M QmNw� ,1 ii n ICE M12A' IY1 i h irA m LkJ P_w Iaft O Supporting documentation or receipt(s) MUST be attached. i�fi o vl� To be paid from i GL Code Budget Line Description IY)ew be r-Sh i I )L e l' Requested by (print): s r I n '+Cf Requested by (signature): Approved by (signature of Division Manager): l on this date 2 2/ A q Ir a; r MTRA is a Chapter Affiliate of ATM MTRA SPRING WORKSHOP REGISTRATION INFORMATION DEADLINE FOR REGISTRATION Friday, March 21, 2008 Name: T r Vx Title: V \C wa,\ on Address: q r(',r (l -�4o,� 2,r\ i- Y I- Ali 220 Phone Number Home Lr �v`f- j Work Email )lip 4X Registration Fee includes continental breakfast and lunch. Please check choice of sandwich: Ham Roast Beef y Turkey Tuna Salad Vegetarian Please list any special needs you may require: Registration Fees: Please check appropriate boxes If you have not renewed your MTRA membership after January 1, 2008, then you will pay the non -MTRA member rate to renew your membership. Student MTRA member rate ($15.00) Student Non -MTRA member rate ($25.00 /includes 2008 membership form attached) Professional MTRA member rate ($60.00) Professional Non MTRA member rate ($75.00 /includes 2008 membership form attached) ,Transcript Fee ($5.00) (needed to prove continuing education points for NCTRC) O Total Enclosed (Make check out to MTRA) Please return registration form (Et attached membership form if applicable) and fee to Questions MTRA Spring Workshop Therapeutic Recreation Program Contact Teresa Beck Grand Valley State University. 616-3 3 1 -2 73 5 Cook -DeVos Center for Health beckt @gvsu.edu Sciences 301 Michigan Street NE, Suite 200 Grand Rapids, MI 49503 MICHIGAN THERAPEUTIC RECREATION ASSOCIATION MEMBERSHIP APPLICATION Name ���5 r Title �u USl hr� ("oc .t r Address 1 32- Ctnk L Er b City: C.�� State zip d 2 Preferred email of contact D jnk r��� _t L�C�4 �L���J Corn Address 2 (If student, permanent address; if professional, home address) Address: 0--. ra Lr. _R iA City: State: zip: Phone (H) Phone (V) Do you wish to be contacted via email for. MTRA announcements (i.e. meeting announcements, upcoming workshops) Yes No Do you wish to have your membership letter and certificate sent via email Yes No Check the Appropriate Blank: Please answer the following (Professionals only please) V Recreation Therapy Professional ($15.00) Voting member 1. Years of experience in TR Certification ,/0-3 12 -15 Expiration Date Col gip/ 4-7 16 -19 Are you a me ber of ATRA? 8 -11 20+ Yes No 2. Primary Population: Supporting Member ($10.00) y Nonvoting member Ltl�yllUl il�lll! (IBC Student Member ($10.00) 3. Organization/Agency: Nonvoting member. An individual enrolled in a Recreation Therapy clrnkd C ,�fi -V education program Of Are you willing to be an intern supervisor? Yes No Can MTRA place your facility name as an internship placement site Yes No Complete this form and return with your workshop registration Annual membership is from January to December of each calendar year. The information gathered on this form is for statistical purposes only and will remain confidential MTRA is a chapter affiliate of ATRA TESS PINTER 56— 641 MICHAEL PINTER 412 1450 PH. 317- 288 -0373 6700042542 8732 MALAGA DRIVE APT 1 A:. DATE L—I TM INDIANAPOLIS, IN 46250 PAY TO THE r ORDER OF A Q ,P DOLLARS 8 �F..�m 4e www.skyfi.com Bank MEMO Ao04 b 20 b936Ao 670004 254 211® b450 Michigan MTRA Therapeutic o Recreation Association Receipt 2008 MTRA Spring Workshop Professional Non -Member Rate $75.00 Transcript Fee for CEU's 5.00 TOTAL $80.00 Paid by: Tess Pinter, CTRS SALES RECEIPT 52 113 50OO20 SHELL 8391 BYRON CENTER BYRON CENTER MI 49315 INVOICE 785824 03/ 9:41 AM AUTH n 743330 VISA ACCOUNT NUMBER XXXX XXXX XXXX 5255 P.INTER!TESS PUMP PRODUCT S/G 04 UNLD $3.349 GALLONS FUEL TOTAL 11.048 537.00 PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO, 101 (1986) MILEAGE CLAIM TO— (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO- FOR [OFFICE, BOARD, DEPARTMENT OR INSTITUTION) SPEEDOMETER DATE FROM TO READING AUTO MILEAGE NATURE OF BUSINESS MILES POINT POINT START FIN TRAVELED PER•MILE 0 L I AUTO LICENSE NO. TOTALS z �qo v S PEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed milea or official highway map. Pursuant to the provisions and penalties of Chapter IS5, Acts 1953, 1 hereby certify that the icregoing account is just and correct, that the amount claimed is legally due, after allowing all Just credits end that no p rL I of the same has been paid. Date ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Pinter, Tess Date Due 4683 Grand Haven Ln Apt H Indianapolis, IN 46280 I Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 80.00 3/28/08 Reimb. Reimb for Dues 242.40 3/29/08 Reimb. Reimb for Travel Expenses 47.12 4/7/08 Reimb. Reimb for Travel Expenses Total 369.52 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 Voucher No. Warrant No. Allowed 20 Pinter, Tess 4683 Grand Haven Ln Apt H Indianapolis, IN 46280 In Sum of i 369.55 ON ACCOUNT OF APPROPRIATION FOR 104 Program Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1047 Reimb. 4355300 80.00 1 hereby certify that the attached invoice(s), or 1047 Reimb. 4343000 242.40 bill(s) is (are) true and correct and that the 1047 Reimb. 4343000 j 47.15 materials or services itemized thereon for which charge is made were ordered and received except 12 -May 2008 Sig t r 369.55 Busine s Se ices Manager Cost distribution ledger classification if Title claim paid motor vehicle highway fund ,I