HomeMy WebLinkAbout205890 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 152500 Page 1 of 1
ONE CIVIC SQUARE INDIANA LEAGUE OF MUN C -T
CARMEL, INDIANA 46032 C/O ANN COTTONGIM CHECK AMOUNT: $247.50
n 200 S MERIDIAN STREET #340
CHECK NUMBER: 205890
INDIANAPOLIS IN 46225
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355300 247.50 ORGANIZATION MEMBER
P 2012 ILMCT ANNUAL DUES NOTICE
Claim and Invoice
Due Date: 2012 Dues for all Classes of Membership due on or before March 1, 2012
I 1"W, �'1-
This invoice and claim for payment is made upon the Clerk, Controller or Clerk- Treasurer of the City or Town,
for payment of membership dues for the Indiana League of Municipal Clerks and Treasurers. You may pay
from this invoice for any classes of membership. Please check the appropriate box to indicate the actual class
of membership and dues schedule which applies.
Active Members:
Towns with population under 700 50.00
Towns or Cities with population of 701 to 5,000 75.00
Towns or Cities with population of 5,001 to 20,000 $100.00
Towns or Cities with population over 20,001 to 35,000 $125.00
Towns or Cities with population over 35,000 $187.50
Please indicate your municipality population
Active Member Name:
Title: 0✓Clerk- Treasurer Clerk Lontroller
Certification (Check all that apply): IAMC CMC MMCA MMC CPFA
Name of Municipality: County Y�ta�iw�C
lUic
Office Address:
U� -f�'
City /Town /Zip: l—r AL�('
Office Phone: J Fax:
Office e -mail: I d r J i
Home Address: City/Town /Zip:
Home Phone:
Financial computer software used v��GC�rc��l��0�I
(This question is being asked this year to assist the Mentor committee in placing people with like software to
assist the new Clerk- Treasurers coming in).
ILMCT Membership Benefits Include:
Notice of League events (includes training and professional development opportunities)
A subscription to the QUEST, the ILMCT official newsletter
In some cases, discounts for League sponsored events
Access to League website www.ILMCT.org
Associate Members: $60.00
(Any former active member or staff of an active member of the league):
Associate Member Name: PJA Title: G L
Address: 000— Cw Vt& N'_r 4 1 6Fy/Town /Zip: 41
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Associate Member Name: Title:
Address: City/Town /Zip:
(Please copy form for additional Associate Members)
Affiliate Members: $60.00
(Any person who is elected or an appointed officer in municipal government who is not already qualified for
another membership class may enjoy all League privileges, except the right to vote and hold office.)
Affiliate Member Name: Title:
Address: City/Town /Zip:
Affiliate Member Name: Title:
Address: City/Town /Zip:
(Please copy form for additional Affiliate Members)
Associate Business Member: $187.50
(Entitled to four (4) membership cards, a membership roster, a Quest subscription and meeting notices)
Associate Business Name: Phone:
Address: City /State /Zip:
1. Primary Contact Name: e-mail:
Address (if different from above)
2. Card Bearer Name: e -mail:
Address (if different from above)
3. Card Bearer Name: e -mail:
Address (if different from above)
4. Card Bearer Name: e-mail:
Address (if different from above)
Checks to be made payable to:
TOTAL ACTIVE MEMBER: Indiana League of Municipal Clerks
TOTAL ASSOCIATE MEMBER and Treasurers or ILMCT
TOTAL AFFLIATE MEMBER Please remit payment to:
TOTAL ASSOCIATE BUSINESS MEMBER ILMCT
Attention: Ann Cottongim
200 South Meridian Street, Suite 340
TOTAL AMOUNT ENCLOSED Indianapolis, Indiana 46225
1 hereby certify that the foregoing is just and correct, that the amount claimed is legally due after allowing for
just credits and that no part of the same has been paid.
,Wales ✓mv vza, Treasurer
PLEASE RETURN A COPY OF THIS INVOICE/CLAIM WITH YOUR REMITTANCE
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
UA Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s or bill(s))
d
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
VOUCHER NO. WARRANT NO.
VA 1.G`Y1 r r �aw ALLOWED 20
IN SUM OF
[YVA C4 �4D
IUD
q1��
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
20
i Signat Ofof
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund