172885 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 155400 Page 1 of 1
0 ;1 ONE CIVIC SQUARE INDIANA STATE BAR ASSOC CHECK AMOUNT: $275.00
Y CARMEL, INDIANA 46032 ONE INDIANA SQUARE, SUITE 530
INDIANAPOLIS IN 46204 -2199 CHECK NUMBER: 172885
CHECK DATE: 5/2712009
DEPARTMENT� ACCOUNT PO NUMBER INVOIC NU MBER AMOU DESCRIPTION
1180 4355300 275.00 ORGANIZATION MEMBER
INDIANA STATE BAR ASSOCIATION
METHOD OF PAYMENT (CHECK ONE BOX)
DUES NOTICE 0
July 1, 2009 -June 30, 2010 VISA MASTERCARD AMERICAN EXPRESS DISCOVER
ONE INDIANA SQUARE, SUITE 530 CARD NUMBER
INDIANAPOLIS, IN 46204 -2199
317 639 -5465 800 266 -2581 Fax: 317-266-2588 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
e -mail: isbaadmin@inbar.org EXP. DATE
YOU MAY PAY DUES ONLINE UPDATE
YOUR MEMBERSHIP INFORMATION: SIGNATURE Verification Code
CHECK
www.inbar.org payable to: Indiana State Bar Association
23811 Automatic Credit Card Renewal Option: By initialing here, your
Douglas C. Haney dues will automatically be charged to your credit card May 1 st of each year
at the appropriate dues rate in existence for the ISBA at the time of renewal.
City of Carmel To cancel your automatic renewal, members must notify the ISBA 10 days
One Civic Square prior to the renewal date.
Carmel, IN 46032
Regular Dues (6 yrs or over) 230.00
Employment Labor Law Section 20.00
ADDRESS, E- MAIL-, PHONE4 FAX CORRECTION REQUESTED ON BACKSIDE Governmental Pr actic e Section 10.90
CHANGES IN SECTION ENROLLMENTS: Please Land Use &Zoning Section 15.00
indicate with an X any section you wish to add. Add new dues voluntal
below.
AGRICULTURAL LAW $20
ALTERNATIVE DISPUTE RESOLUTION $20 Total
APPELLATE PRACTICE $20 325.00
BANKRUPTCY CREDITORS' RIGHTS $30
BUSINESS LAW $10
CONSTRUCTION SURETY $20
CORPORATE COUNSEL $10 Amount Paid'
CRIMINAL JUSTICE $20
ELDER LAW $20
EMPLOYMENT LABOR LAW $20
ENVIRONMENTAL LAW $25
FAMILY JUVENILE LAW $15
GENERAL PRACTICE SOLO SMALL FIRM $15
GOVERNMENTAL PRACTICE $10
HEALTH LAW $15
INTELLECTUAL PROPERTY $10
INTERNATIONAL LAW $15
fV LAND USE ZONING $15
LITIGATION $15
PLEADS Prof. Legal Ed., Admissions Development) $15
PROBATE, TRUST REAL PROPERTY $20
SENIO LAWYERS $15
TAXATION $25
UTILITY LAW $20
YOUNG LAWYERS $10 INCLUDE THIS PORTION WITH REMITTANCE.
See reverse side for important information regarding tax deductions.
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❑OFFICE
Membership Dues and Section Dues are not tax deductible as charitable
contributions, but a portion may be tax deductible under other provisions
CITY STATE ZIP of the Internal Revenue Code. This year, $3.00 of your dues were used
for lobbying expenses and may not be tax deductible.
The Indiana Bar Foundation is a 501(c)(3) organization. The $40.00 listed
FIRM, EMPLOYER NAME OR PUBLIC OFFICE is a charitable contribution.
BARPAC is a political action committee. The $10.00 contribution listed is
voluntary and not tax deductible. Members of the judiciary are not
AREA OF PRACTICE expected to contribute to BARPAC. (See Canon 4, Indiana Code of
Judicial Conduct.)
$5.00 is allocated from your dues payment for your Res Gestae
PLEASE CHECK THE APPROPRIATE BOXES. subscription.
a. FEMALE b. MALE
1. ❑AFRICAN AMERICAN 2.❑ AMERICAN INDIAN 3.❑ ASIAN
4. ❑CAUCASIAN 5. ❑HISPANIC 6.0 OTHER
INDIANA RETAIL TAX EXEMPT PAGE
Cl of C rmel CERTIFICATE NO. 0031 20155 002 0 PURCHASE ORDER NUMBER
e�
A FEDERAL EXCISE TAX EXEMPT C _q
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 48032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
VENDOR SHIP
TO
`l�°:
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
a° i 5 -x
_4
ra
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT c
M M
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
gr`/f GL LC L �w NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
�d VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. p
DOCUMENT CONTROL NO.
A4. COPY -SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. NO.
ALLOWED 20
a z� IN THE SUM OF
G� t 3a
O CCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
ruoT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
0 materials or services itemized thereon for
which charge is made were ordered and
received except_
200?
Si
;Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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