HomeMy WebLinkAbout205500 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 354777 Page 1 of 1
ONE CIVIC SQUARE INDIANA SWAT OFFICERS ASSOCIATIO
CARMEL, INDIANA 46032 ATTN: TOM KUHLENSCHMIDT HECK AMOUNT: $250.00
PO BOX 1016 CHECK NUMBER: 205500
CROWN POINT IN 46308
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 250.00 ORGANIZATION MEMBER
INVOICE
January 10, 2012
City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
2012 Team Membership Dues
TOTAL AMOUNT DUE: $250.00
Please make check payable to:
Indiana SWAT Officers Association
ATTN: Tom Kuhlenschmidt
P.O. Box 1016
Crown Point, IN 46308
INDIANA SWAB D-FFICERs Assac
2012 TEAM MEMBERSHIP APPLICATION
Federal Tax Number: 57- 11779 3
eam Membership $175 (12 members or less) La Team Membership $250 (13 members or more)
`For a multi agency Team, please complete a Registration Form for each Agency's Team Member(s).
AGENCY NAME /MILITARY UNIT
Carmel Police Department
CONTACT PERSDNLt. Jeff Horner
ASSIGNMENT /TITLE i eam commana _ET irl
AGENCY ADDRE55 Civic Square CITY Carmel I 46032
STATE n 21P CODE
PREFERRED TELEPHONE NUMBER 317 571 EXTENSION FAX NUMBER 317- 571 -2573 PREFERRED E -MAIL ADDRESS
2500
T L
15T TEAM MEMBER NAME Jeff Horner 'FtEFEKKED t= [L f�UUKEJJ
j Jn.gov
2ND TEAM MEMBER NAME Ryan Jellison PREFERRED E -MAIL ADDRESS
rjellison@carmet.in.gov
3RD TEAM MEMBER NAME Brady Myers PREFERRED E -MAIL ADDRESS
bmyers@carmet.in.gov
4TH TEAM MEMBER NAME Shane Collins PREFERRED E -MAIL ADDRESS
scot [ins@carmet. in.gov
5TH TEAM MEMBER NAME Curtis Scott PREFERRED E -MAIL ADDRESS
cscott@carmet.in.gov
6TH TEAM MEMBER NAME Ben Fisher PREFERRED E -MAIL ADDRESS
cfisher@carmel.in.gov
7TH TEAM MEMBER NAME Wit Gilbert PREFERRED E -MAIL ADDRESS
wgilbert@carmel.in.gov
8TH TEAM MEMBER NAME Mark Paris PREFERRED E -MAIL ADDRESS
mparis@carmet.in.gov
9TH TEAM MEMBER NAME Scott Long PREFERRED E -MAIL ADDRESS
slong@carmel.in.gov
1OTH TEAM MEMBER NAMEGreg Loveall PREFERRED E -MAIL ADDRESS
glovea[L@carmel.in.gov
11TH TEAM MEMBER NAME Bob Locke PREFERRED E -MAIL ADDRESS
rtocke@carmet.in.gov
12TH TEAM MEMBER NAME Todd Clark l PREFERRED E -MAIL ADDRESS
tclark@carmel.in.gov
We aff irm that the above information is true and accurate. Further, we authorize the Indiana SWAT
Officers Association to contact our employer and verify our employment and assignment, if necessary.
;Please. remit completed application with payment to i
;Indiana Slhll�► Officers Assocoatpon v
t 4ttn: Tom Kuhlenschmidt y
P.O. BOX 101
F
Crown Point, Indiana.46308
If an invoice is,r6quired,prior'to seniiing payment,. please contact Tom at!
(219) 488 -4421 or 6,417 it him iff"Auhla x150 @yahoo.Com
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))
01/10/12 membership dues $250.00
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
VOUCHER NO. WARRANT N
ALLOWED 20
Indiana SWAT Officers Association
Tom Kuhlenschmidt
IN SUM OF
P.O. Box 1016
Crown Point, IN 46308
$250.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1110 43- 553.00 $250.00
I hereby certify that the attached invoice(s), or
I I
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
Thursday, January 12, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund