169477 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362629 Page 1 of 1
i,
ONE CIVIC SQUARE INDIANA DIV OF INTNTL ASSOC FOR ID
CARMEL, INDIANA 46032 4519 MAPLE TERRACE PARKWAY CHECK AMOUNT: $15.00
FORT WAYNE IN 46835 CHECK NUMBER: 169477
CHECK DATE: 3/4/2009
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 15.00 ORGANIZATION MEMBER
INDIANA DIVISION OF
THE INTERNATIONAL ASSOCIATION FOR IDENTIFICATION
FEDERAL EMPLOYER IDENTIFICATION NUMBER 35- 1934954
Eric Black, Secretary- Treasurer
4519 Maple Terrace Pkwy.
Fort Wayne, Indiana 46835
ericb2771(verizon.net
2009 MEMBERSHIP RENEWAL
Please complete this form to renew your Indiana IAI membership for 2009 and return the signed original, with a
check or money order for $15.00 payable to "Indiana Division IAI," to the Secretary Treasurer at the above address. The
information on this form will be used to prepare the Member Directory, so please check addresses, telephone numbers, and e-
mail addresses for accuracy. Your membership letter will be sent upon receipt of your renewal form and dues payment.
Members must pay annual clues on or before April I each year to remain in good standing.
INDIANA IAI MEMBER NUMBER MEMBERSHIP LEVEL: ACTIVE El ASSOCIATE
NAME 1�,oec'
ACTIVE
ARE YOU A MEMBER OF THE IAI PARENT BODY? OYES: MEM ER NUMBER NO
EMPLOYER AGENCY OR COMPANY a
"1
TITLE OR POSITION
OFFICE A
CITY l rn2 STATE /A ZIP CODE
OFFICE TELEPHONE NUMBER I) 6-111-A 1 -A 0[962 FAX NUMBER on 7 1
OFFICE E -MAIL ADDRESS
CHANGES FROM PRIOR YEAR �I Z/
I wish to renew my membership in the Indiana Division of the International Association for Identification. I
continue to meet all requirements as stated in the Constitution and Bylaws.
MEMBER'S SIGNATURE Q DATE
[Al Office Use Only
RECEIVED FORM OF PAYMENT
RECEIPT NUMBER RECORD UPDATED MEMBERNOTIFIED
43cribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (Rev. 7995)
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
Indiana Division of The International Purchase Order No.
Association for Zdentifcation
4519 Maple Terrace Parkway Terms
Fort Wayne, IN 46835
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2/27/09 member'ship renewal 15.00
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
VOU CHER NO. WARRANT NO.
ALLOWED 20
I ndiana Division of the International IN SUM OF
Association for Identification
4519 Maple Terrace Parkway
F ort Wayne, IN 46835
15.00
ON ACCOUNT OF APPROPRIATION FOR
p olice genera fu
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 553 15.00 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
February 27 20 09
&�d I
Signature
Chief-'of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund