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HomeMy WebLinkAbout173252 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 361329 Page 1 of 1 ONE CIVIC SQUARE CLAY CAMPBELL CHECK AMOUNT: $653.10 CARMEL, INDIANA 46032 9003 MAX COURT Mi eH `off FISHERS IN 46037 CHECK NUMBER: 173252 CHECK DATE: 6/1012009 DE A PO N UMBER INVOICE NUMBER A DESCRIPTION J b01 5023990 408.19 TUITION 651 5023990 244.91 TUITION QuikPAY(R) Print Payment Receipt Page 1 of 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 4188903 Payment Date: May 21, 2009 at 9:49 PM, EDT Effective Date: May 22, 2009 Primary User Id: 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $1,078.39 Cardholder's Name: Sara M Campbell Payment Method: VISA **********8985 Address Info 9003 Max Court Fishers, IN 46037 Contact_I nfa-�31 Page 1 of 1 VENDOR: 361329 CITY OF CARMEL, INDIANA CLAY CAMPBELL CHECK AMOUNT: $653.10 ONE CIVIC SQUARE 9003 MAX COURT CHECK NUMBER: 173252 CARMEL, INDIANA 46032 FISHERS IN 46037 CHECK DATE: 611012009 AMOU DESCRIPTION D ACCO PO NUMBE IN VOI CE NUM BER 408.19 TUITION 601 5023990 244.91 TUITION 651 5023990 IAN UNIVERSITY O IUPUI Bo o 02of the Bursar Account Statement scum Statement Date: 02/03/09 Page 1 of 1 Due Date 02/17/09 Billing Reference: IN BILL# XXX1433002 Previous Balance 0.00 University ID: 0001963789 Minimum -Due. 1,003.39 Student Name: Campbell,Clay Samuel Total Due" 1,003.39 Statement notification sent to clscampb @iupui.edu Charges and Adjustments 01/08/09 Activity Fee 68.45 01/08/09 Resident Undergraduate Fees 1,306.20 01/08/09 Technology Fee 118.10 01/08/09 Athletic Development Fee (SAF) 38 01/08/09 General Services Fee 20.00 01/26/09 Resident Undergraduate Fees 489.82 C 01/26/09 Activity Fee 13.79 C 01/26/09 Technology Fee 44.32 C R Total Charges and Adjustments: 1,003.39 Messages Please see a copy of the IUPUI Bursar newsletter at www.bursar.iupui.edu The University reserves the right to restrict services, deny registration, impose late fees, assess returned item service charges, terminate any If paying by check we may choose to convert your paper check into an electronic transaction. The amount of your check may appear as an electronic You agree that if another person submits a check on your behalf, that individual is considered your agent and was provided with the information on Make payment online at httpJ /onestarLiu.edu If mailing payment, include the bottom portion of this statement and make check payable to: INDIANA UNIVERSITY -detach IUPUI Office of the Bursar University 4D.. 0001963789 PO Box 6020 Due Date 02/17/09 Indianapolis, IN 46206 -6020 Minimum Due 1,003.39 Total Due 1,003.39 Amount Enclosed Campbell,Clay Samuel 9003 Max Ct Fishers, IN 46037 USA IUPUI Lockbox Payment Processing Center PO Box 7245 Indianapolis, IN 46206 -7245 AIUINA000196378900000000100339000000001003395 City Of Carmel oppA Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head rim or to commencement of course.) Employee Name o� I Department UJaAt�f U�Jli CS M f SSN 2) �'31 7 HireDate V Educational Institution* T U P U T Name of Course P f U S C: v\( oc, f U i5 tc� rU M j u 15 Credit Hours Starting Date of Course (month /day /year) O 5 By signing below, I signify that I understand the following: The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -58. To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy of my final grade. To receive reimbursement for books, I must submit an original itemized receipt or other proof of purchase that links these books to this particular course. If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will repay the City in full for its tuition and book reimbursements for this course. The tax status of reimbursement payments is subject to federallaw, which may change from time to time. Employee Signature Date 01­Q9 Part II (to be completed by Department Head) (Submit to Human Resources) By signing below, I certify that the applicant will have been employed full -time by the City for at least one (1) year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension or demotion within 90 days prior to the beginning of the course. The- final claim will be paid from my department's budget, subject to the terms of Section 2 -58 of Carmel City Code.. Department Head Signature Date d Part III (to be completed by Director of Human Resources) Final Approval Date l c C l O� If denied, reason for denial The tuition reimbursement program covers only full- semester courses offered through a degree granting institution accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor. An application will not be considered complete unless a course description from the school's literature is attached. Prescribed by State Board of Accounts amity rorm No. Zu 1 k"ev i aao) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee T1006 CAMPBELL, CLAY Purchase Order No. CARMEL UTILITIES Terms Due Date 6/3/2009 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/3/2009 060809 $408.19 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer l ✓OUCH,ER .092011 WARRANT ALLOWED T1006 IN SUM OF 'AMPBELL, CLAY ,ARMEL UTILITIES Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members 'O INV ACCT AMOUNT Audit Trail Code 060809 01- 6040 -07 $408.19 i I 1 Voucher Total $408.19 Cost distribution ledger classification if claim paid under vehicle highway fund INDIANA O IUPUI Box 020 of the Bursar Account Statement Statement Date: 02/03/09 Page 1 of 1 Due pate 02/17109 Billing Reference: IN BILL# XXX1433002 Previous Balance, 0.00 University ID: 0001963789 w Minimum ,Due; 1,003.39 Student Name: Campbell,Clay Samuel Total;pue 1,003.39 Statement notification sent to clscampb @iupui.edu Charges and Adjustments 01/08/09 Activity Fee 68.45 01/08/09 Resident Undergraduate Fees 1,306.20 01/08/09 Technology Fee 118.10 01/08/09 Athletic Development Fee (SAF) 38.57 01/08/09 General Services Fee 20.00 01/26/09 Resident Undergraduate Fees 489.82 CR 01/26/09 Activity Fee 13.79 CR 01/26/09 Technology Fee 44.32 CR Total Charges and Adjustments: 1,003.39 Messages d =3.1 6 Please see a copy of the IUPUI Bursar newsletter at www.bursar.iupui edu The University reserves the right to restrict services, deny registration, impose late fees, assess returned item service charges, terminate any If paying by check we may choose to convert your paper check into an electronic transaction. The amount of your check may appear as an electronic You agree that if another person submits a check on your behalf, that individual is considered your agent and was provided with the information on Make payment online at http: /onestartiu.edu If mailing payment, include the bottom portion of this statement and make check payable to: INDIANA UNIVERSITY detach IUPUI Office of the Bursar University ID, 0001963789 PO Box 6020 Due Date 0 Indianapolis, IN 46206- 6020 Mmimum Due 1,003.39 Total Due 1,003.39 Am_ ount Enclosed Campbell,Clay Samuel 9003 Max Ct Fishers, IN 46037 IUPUI Lockbox USA Payment Processing Center PO Box 7245 Indianapolis, IN 46206 -7245 AIUINA0001963? 8900000000100339000000001003395 View My Grades Yage 1 of 2 Go to Bottom Student Center Clay Cam pbell j Search for Classes �I Academic Planning it My Academics Grades 1 View My Grades 5pring 20 change term n Class Grades Spring 2003 Official Grades Class Description I Units j Grading Grade I Grade Points CLAS -C CLASSICAL 3.00 Graded A 12.000 205 MYTHOLOGY HIST -J 495 PROSEMINAR FOR 3.00 Withdrawn W HISTORY MAJORS Term Statistics Spring 2003 From Cumulative Enrollment Total Units Toward GPA: Taken 3.000 77.000 Passed 3.000 74.000 Units Not for GPA: Taken 50.000 Passed 50.000 GPA Calculation Total Grade Points 12.000 213.600 Units Taken Toward GPA 3.000 77.000 GPA 4.000 2.774 Transfer Credit column information reflects the Transfer, Test and Special /Other Credit for this term. Statistics represent the grade points and hours as evaluated by the academic policies of your academic school /program. Go to "My Academics Grades" to run an Indiana University unofficial transcript to view your Indiana University GPA and Hours in addition to your Student Program statistics. vnllne tsanlcing t ransac ti on 1J e t a 11 rage 1 0 1 1 �r ibar k:e6m Fie4'p Si ,n Off onlii BA ua11;irfarErai`fr1a� rlli�F -mils It; -y f ut5tnAYr?e arsi,r �rtSl Cyfai i r�iel4;xti� Account overview Transaction Detail Accou Activity Here's a summary of your completed transaction. You may add a note or Online Statements categorize this transaction now. When you're done, click "Save changes." Doan nioad Transactions Manage Categories Completed Ons 05/26/2009 Create a banking report bescripti6n3 CHECK CARD PURCHASE MERCHANT PURCHASE TERMINAL 471705 IUPUI BURSAR WEB P AYMENT317 27424 IN 05 -22 -09 SEQ 914229731427 Amtounf $1,078.39 Transaction Type: WITHDRAWAL Personal Mote (Optional) School Nq &i Online Guo ran irte Category (Optional Not Categorized Add a new category to the list MMW �a Previous transaction Next transaction Return to Account .activity How do I? Glossary FAQs Copyright 2009 Marshall Ilsley Corporation. All Rights Reserved. Member FDIC. A i✓eil =uiy Disclosures SiLe Disclai neFs Your Privacy LENDER l.s+... /,.:L.•. :L.....7,:.•. -----i_[tii-'�r�riw �_..rr.--- .r •i �A.. A........ City Of Carmel Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head rip for to commencement of course.) Employee Name 0_ 6 Department Wc� f Ut SSN 1 7 Hire Date Educational Institution* T U P Name of Course U t U G Credit Hours Starting Date of Course (month/day /year) By signing below, I signify that I understand the following:. The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -58. To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy of my final grade. To receive reimbursement for books, I must submit an original itemized receipt or other proof of purchase that links these books to this particular course. If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will repay the City in full for its tuition and book reimbursements for this course. The tax status of reimbursement payments is subject to federal law, which may change from time to time. Employee Signature Date U l 01 V Part II (to be completed by Department Head) (Submit to Human Resources) By signing below, I certify that the applicant will have been employed full -time by the City for at least one (1) year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension or demotion within 90 days prior to the beginning of the course. The final claim will be paid from my department's budget, subject to the terms of Section 2 -58 of Carmel City Code. Department Head Signature Z i Date f� Part III (to be completed by Director of Human Resources) Final Approval 6-- Date a O If denied, reason for denial The tuition reimbursement program covers only full- semester courses offered through a degree granting institution accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor. An application will not be considered complete unless a course description from the school's literature is attached. City Of Carmel Dow S Tuition Reimbursement Application Form Part I (to be completed by employee) (Please print. Submit completed form to Department Head rim or to commencement of course.) Employee Name o Department UJot -At �r U I Cb ice) SSN Sq 3 J5 7 Hire Date Educational Institution* T V P U 1 Name of Course* P r o s U �t �S �G sy M e,) u I E) Credit Hours Starting Date of Course (month/day /year) By signing below, I signify that I understand the following: The tuition reimbursement program is subject to the terms of Carmel City Code, Section 2 -58. To receive reimbursement for tuition, I must submit evidence of payment for the course and a copy of my final grade. To receive reimbursement for books, I must submit an original itemized receipt or other proof of purchase that links these books to this particular course. If I leave City of Carmel employment sooner than one (1) year after the end of this course, I will repay the City in full for its tuition and book reimbursements for this course. The tax status of reimbursement payments is subject to federa w, which may change from time to time. Employee Signature L Date 0 1 09 0. v Part II (to be completed by Department Head) (Submit to Human Resources) By signing below, I certify that the applicant will have been employed full -time by the City for at least one (1) year prior to the commencement of the course, and has not been subject to a disciplinary probation, suspension or demotion within 90 days prior to the beginning of the course. The final claim will be paid from my department's budget, subject to the terms of Section 2 -58 of Carmel City Code. Department Head Signature Date Part III (to be completed by Director of Human Resources) Final Approval Date l Aa C r o�j If denied, reason for denial The tuition reimbursement program covers only full- semester courses offered through a degree granting institution accredited by the North Central Association of Colleges and Schools or an equivalent regional accreditor. An application will not be considered complete unless a course description from the school's literature is attached. YU1 rti x krc) rruiL rayzncnL ICCCClpL 1 Ul 1 Payment Receipt This is your receipt. Your payment has been submitted. Thank you. Confirmation Number: 4188903 Payment Date: May 21, 2009 at 9:49 PM, EDT Effective Date: May 22, 2009 Primary User Id: 0001963789 Primary User Name: Clay Samuel Campbell Account: Indianapolis Payment Amount: $1,078.39 Cardholder's Name: Sara M Campbell Payment Method: VISA *'"°""""''8985 Address Info 9003 Max Court Fishers, IN 46037 Contact Info: (317)441 -8764 (daytime phone) Your payment has been received by Indiana University. 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee T1005 CAMPBELL, CLAY Purchase Order No. CARMEL UTILITIES Terms Due Date 6/3/2009 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/3/2009 060809 $244.91 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer VOUCHER 095768 WARRANT ALLOWED -T1005 IN SUM OF CAMPBELL, CLAY CARMEL UTILITIES Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 060809 01- 7040 -07 $244.91 l Voucher Total $244.91 Cost distribution ledger classification if claim paid under vehicle highway fund