168432 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00353420 Page 1 of 1
ONE CIVIC SQUARE GEORGE W DAVIS CHECK AMOUNT: $75.00
CARMEL, INDIANA 46032 3854 CORNWALLIS LANE
CARMEL IN 46032 CHECK NUMBER: 168432
.c' CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INV NUMBER AMOUNT DESCRIPTION
1110 4357004 75.00 EXTERNAL INSTRUCT FEE
I
4 r 20-667/740
`GEORGE W. DAVIS io6ss6s
KAREN O. DAVIS
3854 CORNWALLIS LANE
CARMEL, IN 46032 -9346
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THE INTERNATIONAL CONFERENCE OF POLICE CHAPLAINS
REGION 4, CENTRAL AREA TRAINING SEMINAR
LAW ENFORCEMENT CHAPLAINS
Indianapolis, IN
MARCH 16-18,2009
PLEASE PRINT CLEARLY Is this your first ICPC training? Yes No
Name: e p e W Do v t 5
G y
Street: NIMS Trained? es No What Level? �Gv
3 5`f G� ray �s 40,9 S262 C2
City: Lo r MV( CISM Trained? Eies No What Level?
State: Law Enforcement Agency Serving: C,�t rN2
Zip: Size of Agency: Q 9 GtJo r^ n
Phone No. (Home): 317— 7 3 3 Z O f Faith Organization: Uri i Q
Phone No. (Office): 5 d No. years in chaplaincy:
Email: k 8 S f<1 (j t o a f Are you career full -time chaplain?
Last 4 of Social Sec. No. (For Academic Credit): Are you paid part -time chaplain? 5
ICPC Member: e No Are you a volunteer chaplain? r
ICPC Credentialed: CBC S CMC Spouse's Name: ka r��, y1
Diplomate Fellow Spouse's first ICPC event? Yes No EotAttendin
Banquet Special Dietary Needs: 1. Must Complete Class Selections on reverse side
Gluten Free 2. One Banquet Ticket is included in registration fee.
Kosher 3. Banquet Tickets must be purchased for Spouse or Guests.
Vegetarian 4. ASIST includes full conference; increased fee is for workshop expenses.
Handicap or Special Needs:
Basic Classes ASIST Your
Enrichment Workshop Conference
Participants Advanced 2 or 3 (Advanced 1) Fees
Checks payable to: ICPC Region 4 ICPC Member $75.00 $125.00
Non member $112.50 $187.50
Mail this completed registration Guest/Spouse
�a
form (front &back) and fees to: Banquet Tickets $30.00 each �5
Subtotal
Alan Goff, Indiana Registrar
Late Registration $25.00
I.C.P.C. Reg. 4 CAT Seminar After February 13
4375 W State Road 32
r
Crawfordsville, IN 47933 -9316
Total Due
Pres -ibed 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
George W. Davis Purchase Order No.
3854 Cornwallis Lane Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/27/09 reimburse Chaplain George Davis for training 75.00
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 N
VQUCHER NO. WARRANT NO.
ALLOWED 20
George W. Davis IN SUM OF
3854 Cornwallis Lane
Carmel, IN $6032
75.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT voice(s), or
DEPT. I hereby certify that the attached in
1110 570 -04 75.00 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
January 30 20 Og
&,,AAd-P.P -b Z'. A
Signature
Chief of P61ice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund