HomeMy WebLinkAbout206830 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 365043 Page 1 of 1
ONE CIVIC SQUARE THE GROUNDWATER FOUNDATION CHECK AMOUNT: $50.00
CARMEL, INDIANA 46032 PO BOX 22558
«o .�o LINCOLN NE 68542 CHECK NUMBER: 206830
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 2012 50.00 DUES
2012 Groundwater Foundation Membership and
Groundwater Guardian Administrative Fee Contribution
Please complete and return this form, along with your Annual Entry paperwork and check or credit card
information, by February 15 for Groundwater Guardians designated the previous year; new
Groundwater Guardians may submit at any time to:
�4r The Groundwater Foundation, P.O. Box 22558, Lincoln, NE 68542 -2558
Payment can also be submitted online at http: /www,groundwater.org /shop /products.asp ?cat =29
Team Contact Name: Jaimie Foreman
Groundwater Guardian Team: Carmel Local Planning Team
We are a Groundwater Guardian: IN Community 0 Affiliate
Mailing Address: 3450 W. 131 st Street
City, State, ZIP, Country: Carmel IN 416074
Phone: 317- 733 -2588 F ax: 317- 733 -2053
Email address: itoreman(c) carmel in gov
*You may also contribute as a Groundwater Foundation member with this form.
Groundwater Guardian Administrative Fee
13 $100 1st year Community
EX $75 Renewing Community ($50 if submitting BEFORE February 15)
O $200 1st year Affiliate
O $150 Renewing Affiliate ($100 if submitting BEFORE February 15)
Membership Options
O $35-74 (Ripple Creator) 71 $75 149 (Cool Springs Contributor)
O $150— 249 (Big Splash Supporter) O $250 499 (Hydro Hero)
O $500 (Groundwater Defender) 0 $1,000— 2,499 (Awesome Aquifer Advocate)
O $2,500 (Blue Planet Protector)
Total Payment: $50 Groundwater Guardiaft one s-
A mnonthly newt/ letter -with
Payment Options program informa tibrran
updates, funding opportunities,
Please charge my VISA or MasterCard for the amount of activity ideas,. success. stories,.
Card number: and more
Access to case studies-
Expiration date: 3 digit security code: successful ac6' es
Opportunities o connect to
The following information must be provided as it appears on your credit card
statement, otherwise we will be unable to process your request. other_Groundwater Guardians
Personalize&news releases.
Cardholder's name: Discounted dr free access
to Groundwater Foundation
Organization's name: webinars
Address: A 10 co
cl unt on Groundwater
ww
catalog.products
City, State, Zip:
All membership dues are tax
Authorized Signature: cdeductibleAhe Ground "water
Guardian odministrdtive feeiis not)'%
1 Enclosed, please find a check made payable to The Groundwater Foundation,
for the amount of 5 n.- c� Federal Tax ID# 3-6-,-341-3--3-51-
VOUCHER 113800 WARRANT ALLOWED
365043 IN SUM OF
THE GROUNDWATER FOUNDATION
PO BOX 22558
LINCOLN, NE WAT
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO* INV ACCT AMOUNT Audit Trail Code
V�� OD
2012 01- 6040 -03
i
Voucher Total $50.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
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
365043
THE GROUNDWATER FOUNDATION Purchase Order No,
PO BOX 22558 Terms
LINCOLN, NE 68542 -2558 Due Date 2/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
220/2012 2012 $50.00
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
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Date O Ki Ae r