209513 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00353019 Page 1 of 1
ONE CIVIC SQUARE ALTON B CHAFIN
CARMEL, INDIANA 46032 C/O WASTEWATER PLANT CHECK AMOUNT: $100.00
CARMEL IN 46032 CHECK NUMBER: 209513
CHECK DATE: 6/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BART 100.00 OTHER EXPENSES
/.(•l OF
CITY OF CARMEL Expense Report (required for all travel expenses)
2010 mileage reimbursement rate is 50 cents /mile
EMPLOYEE NAME: Bart Chafin DEPARTED na TIME:
DEPARTMENT: Utilities /Sewer RETURN na TIME:
REASON FOR TRAVEL: na DESTINATION CITY: na
EXPENSES ARE FOR (check all that apply): TRAVEL ADVANCE TRAVEL REIMBURSEMENT X_ TRAVEL PER DIEM
Date Transportation Gas/Tolls/ Lodging Meals Misc. Total
Air -fare Car Rental Other Parking Breakfast Lunch I Dinner I Snacks Per Diem
5/8/12 Activated Sludge I Course $25.00 $25.00
5/10/12 Solids Dewatering $25.00 $25.00
5/10/12 Solids Handling Alternatives $25.00 $25.00
5/22/12 Pri ary Treatment $25.00 $25.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0.00
Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.001 $0.001 $0.001 $0.00 $100.00 0 0 o e
DIRECTOR'S STATEMENT: I hereby affirm that all expenses listed conform to the City's travel policy and are within my department's appropriated budget.
Director Signature: Date:
City of Carmel Form ER06 Revision Date 5/24/2012 Page 1
Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1
From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM>
To: Alton Chafin <BCroc @aol.com>
Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation
Date: Tue, May 8, 2012 11:35 am
Thank you for your order!
Order Information
Merchant: Approved Enviroment Inc
Description: Activated Sludge I
Invoice Number: 706C
Billing Information Shipping Information
Alton Chafin Bart Chafin
Camel Wastewater Treatment Plant Carmel Wastewater Treatment Plant
12347 Touchdown Dr. 12347 Touchdown Dr.
Fishers, In 46037 Fishers, In 46037
Hamilton Hamilton
BCroc(cDaol.com
317/773/6923
Total: US $25.00
Visa
Date/Time: 08- May -2012 08:35:13 AM PT
Transaction ID: 4363853544
http: /mail.aol.com/36081 -111 /aol-6/en-us/mail/PrintMes sage. aspx 5/23/2012
WASTEWATER OPERATOR /APPRENTICE CONTINUING To ensure proper credit, the wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
p:
State Form 51139 (R3 4 -08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT T l j�~7 ��r
166 YV Vv 1 VV6
Operator ❑Apprentice Technical 1oHOUR ours Earned:
General Contact Hours Earned:
0
01' R
ate. >c _a,,,u..�...�,. e��.b .✓y. :ax:.., se
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) days of the
conclusion of the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65 -42
Indianapolis, IN 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a three (3) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attendin the entire wastewater operator continuing education course.
.CERTIFIED QPE,R�ATQ (WO RIVIATIQN,��
1. NAME:
2. ADDRESS (number and street
City: `i„ State: ZIP cod Telephone number:
F 1IL6 Work: 1 V13
Home /Cell: C
Check here if this is an address change E -mail Address:
i
3. NAME OF TRAINING COURSE:
A C_ X 'j'\j A j S�v10
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
WWW.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATORIAPPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
I, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. 1 also understand that any omissions or misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
Ann Bersbach
12. SIGNATURE I OF CERTIFIE -OPE TOR/APPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
A S. L j tom? R 6
14. CONTINUING EDUCATION CREDIf HOURS ARE TO BE APPLIED TO:
Operator certification /air -nticeyiCTber. Clas Expiration date:
W W O 1711 1 K
Operator certification /apprentice number :v Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 241 -9858
Email: SupportCa).approvedee.com
Certificate ®f Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina, North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Alton Bart Chaffin
Address: 12747 Touchdown Dr., Fishers, In 46037
Course Title: Activated Sludge I
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5907 TOI -G00, OH OEPA- S296727 -OM, NC
CEO 1130402, MD 3466- 05 -06, KY 10296
Date: 5/8/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17998
Operator Class Level: 3
License Expiration Date: 06/30/2012
Operator Signature: Givim
Training Provider Signature
Ann Bersbach, Approved Environment, Inc.
Copyright 2002. Approved Environment, Inc., Indianapolis, Indiana
http:// www. approvedce. com/ ontineCEUs /ceuCertificateOfCompletion.asp 5/8/2012
Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1
From: APPROVED ENVIRONMENT <SUPPORT @APP ROVEDCE.COM>
To: Bart Chafin <BCroc @aol.com>
Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation
Date: Thu, May 10, 2012 1:57 pm
Thank you for your order!
Order Information
Merchant: Approved Enviroment Inc
Description: Solids Dewatering
Invoice Number: 719C
Billing Information Shipping Information
Bart Chafin
Carmel Wastewater Treatment Plant
12747 Touchdown Dr.
Fishers, In 46037
Hamilton
BCroc(@aol.co
317- 773 -6923
Total: US $25.00
Visa
Date/Time: 10- May -2012 10:57:05 AM PT
Transaction 10: 4369123025
http: /mail.aol.com/36081 -111 aol- 6 /en- us /mail/PrintMes sage. aspx 5/23/2012
e R°� To ensure p roper credit, the
WASTEWATER OPERATOR /APPRENTICE CONTINUING p p
wastewater approval number
EDUCATION CREDIT REPORT
MUST be provided.
State Form 51139 (R3 4 -08) Training Course Approval Number:
esie�
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT T <lS Thj�l` 3
Technical Contact Hours Earned:
26 perator ❑Apprentice 1 HOUR
General Contact Hours Earned:
0
IiNSTRIJCTION,S
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) days of the
conclusion of the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65 -42
Indianapolis, IN 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a three (3) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attendin the entire wastewater operator continuing education course.
.i...... GRTIFtDAERATOR/APP,R7 hITIC,E 1t!tFORIIlIAT10.N
1. NAME:
2. ADDRESS (number and street):
`1 7-
City: State: ZIP co +dyer Telephone number:
Work:
b
Home /Cell: 2r" 3i7 °'773
Check here if this is an address change E -mail Address:
CO.IJRSEIMF®RIVIATION,,
3. NAME OF TRAINING COURSE:
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
1 16 j")-- WNW.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
1, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
1,10 Ann Bersbach
12. SIGNATUIJE OF CEfD OPE� OR/ PPRENTICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
1 oat A L T c*j f i+A j Dr-
14. CONTINUING EDUCATION CREDIT HOUIKS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
y QV/0 '7 1 'Y 6 /3p) 20
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Boa 42744
Indianapolis, IN 46242
1- 877 241 -9858
Email: Support(d..approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama, Delaware, South
Carolina. North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Alton Bart Chafin
Address: 12747 Touchdown Dr., Fishers, In 46037
Course Title: Solids Dewatering
Course Value: 1 Contact Hour
Approval Number: IN WWT11 -5910 TOI -GOO, OH OEPA- 5296751 -OM, NC
CEO 1140403, MD 3469- 05 -06, KY 10302
Date: 5/13/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: wwO17998
Operator Class Level: 3
License Expiration Date: 06/30/2012
Operator Signature: a&
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/13/2012
Approved Enviroment Inc Customer Receipt /Purchase Confirmation Page 1 of 1
From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM>
To: Alton Chafin <BCroc @aol.com>
Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation
Date: Thu, May 10, 2012 3:40 pm
Thank you for your order!
Order Information
Merchant: Approved Enviroment Inc
Description: Solids Handling Alternatives
Invoice Number: 721C
Billing Information Shipping Information
Alton Chafin
Carmel Wastewater Treatment Plant
12747 Touchdown Dr.
Fishers, In. 46037
Hamilton
BCroc(a)aol.com
317/773/6923
Total: US $25.00
Visa
Date/Time: 10- May -2012 12:40:00 PM PT
Transaction ID: 4369423683
http: Hmail. aol.com/3 6081 -111 aol- 6 /en- us /mail/PrintMessage.aspx 5/23/2012
STA To ensure proper credit, the
WASTEWATER OPERATOR /APPRENTICE CONTINUING wastewater approval number
EDUCATION CREDIT REPORT
MUST be provided.
m!
State Form 51139 (R3 4 -08) Training Course Approval Number:
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT ��e i �a'��.�
perator ❑Apprentice Technical 1oHOUR ours Earned:
General Contact Hours Earned:
0
a x ��IIVSTRUCTIONS�� ��d x
...W:.� �.o.,
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) days of the
conclusion of the wastewater treatment continuing education course: Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65 -42
Indianapolis, IN 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a three (3) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attendIn the entire wastewater o erator continuing education course.
�y,k GI= RfIFtED�OPER,4TQR /PRE[VTICE I,fFORIUlAT10N v
1. NAME: I\ 5
2. ADDRESS (number and street):
I 2D 1 4
f1txCN �C
City: State: ZIP code: Eme/Cell: lephone number: 0
F 2 51') `x L •3� w/. ?)'Y7 '13 023
Check here if this is an address change E -mail Address:
GOtJ,RSE..,INFORMAT(ON' W"
EN
3. NAME OF TRAINING COURSE:
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
VWVW.APPROVEDCE.COM
8. TOTAL NUMBIER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
I, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
10&. Ann Bersbach
12. SIGNATURE OF CERTIFff OPERATQR7 PPRE TICE: 13. PRINTED NAME OF CERTIFIED OPERATOR/APPRENTICE:
14. CONTINUING EDUCATION CREDIT HOURS AR <TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, IN 46242
1- 877 241 -9858
Email: Support(a),approvedee.com
Certificate Of Completion
Courses are approved in the following states: ndiana, Illinois, Ohio, Alabama, Delaware, South
Carolina. North Carolina, Maryland, Kentucky and Ontario, Canada.
Name: Alton Bart Chafin
.Address: 12747 Touchdown Dr., Fishers, In 46037
Course Title: Solids Handling Alternatives
Course Value: 1 Contact Hour
Approval Number: IN WWTI 1 -5912 T01-G00,, OH OEPA- 5296742 -OM, NC
CE02030403, MD 3471- 05 -06, KY 10301
Date: 5/16/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: ww017998
Operator Class Level: 3
License Expiration Date: 06/30/2012
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002. Approved Environment, Inc., Indianapolis, Indiana
http:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion.asp 5/16/2012
Approved Enviroment Inc Customer Receipt/Purchase Confirmation Page 1 of 1
From: APPROVED ENVIRONMENT <SUPPORT @APPROVEDCE.COM>
To: Alton Chafin <BCroc @aol.com>
Subject: Approved Enviroment Inc Customer Receipt/Purchase Confirmation
Date: Tue, May 22, 2012 2:05 pm
Thank you for your order!
Order Information
Merchant: Approved Enviroment Inc
Description: Primary Treatment
Invoice Number: 832C
Billing Information Shipping Information
Alton Chafin
City Of Carmel
12747 Touchdown Dr.
Fishers, In 46037
Hamilton
BCroc .aol.com
317- 773 -6923
Total: US $25.00
Visa
Date/Time: 22- May -2012 11:05:15 AM PT
Transaction ID: 4394312927
http://mail.aol.com/36081-1 1 I /aol- 6 /en- us /mail/PrintMessage. aspx 5/23/2012
WASTEWATER OPERATOR/APPRENTICE CONTINUING To ensure proper credit, the
wastewater approval number
EDUCATION CREDIT REPORT MUST be provided.
a
State Form 51139 (R3 4 -08) Training Course Approval Number:
'y` _i` INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT w 560' -Qoo
�A 16
Aerator ❑Apprentice Technical 1 °HOUR ours Earned:
General Contact Hours Earned:
0
`[IdSTRUGTIONS
In accordance with 327 IAC 5- 22- 17(c), the training provider must submit this form within ninety (90) days of the
conclusion of the wastewater treatment continuing education course. Mail the completed form to:
Wastewater Continuing Education Coordinator
Indiana Dept. of Environmental Management
100 N. Senate Ave Mail Code 65 -42
Indianapolis, IN 46204 -2251
Incomplete forms will be returned to the training course provider for completion and resubmittal to IDEM.
Partial course credit shall not be given to instructors, speakers, or students participating in less than a complete
wastewater treatment continuing education course.
The training provider must retain a copy of this form for their records for a three (3) year period following the
presentation of each wastewater treatment continuing education course.
Training providers are encouraged to provide a copy of the completed and signed credit reporting form to the
certified operator/apprentice attendin the entire wastewater operator continuing education course.
1. NAME
L aj Bq f� j C)4 F -lam
2. ADDRESS (number and street):
City: c State: ZIP cqod►e: Telephone number:
SN�r -S +tom "7 b V�� Work:
Home /Cell: 53
Check here if this is an address change E -mail Address:
`3N n C0_t1RSE,INF,,ORMATI,ON .4��a12.
3. NAME OF TRAINING COURSE:
3mAXY N
4. NAME OF TRAINING COURSE PROVIDER: 5. NAME OF ORGANIZATION SPONSORING COURSE:
APPROVED ENVIRONMENT INC SAME
6. DATE(S) ATTENDED (month, day, year): 7. LOCATION ATTENDED:
22. 2- 00— VWVW.APPROVEDCE.COM
8. TOTAL NUMBER OF CONTACT HOURS ATTENDED BY CERTIFIED OPERATOR/APPRENTICE AND VERIFIED BY INSTRUCTOR AND
TRAINING COURSE PROVIDER:
Technical Contact Hours: General Contact Hours:
1 HOUR 0
9. CERTIFICATE OF COMPLETION IS REQUIRED FOR ALL ON -LINE COURSES.
1, the undersigned, certify under penalty of law that this document (and any attachments) were prepared under my direction or supervision and that the
information submitted is, to the best of my knowledge and belief, true, accurate, and correct. I also understand that any omissions or misrepresentation
may result in the denial of continuing education credit for this course.
10. SIGNATURE OF INSTRUCTOR: 11. PRINTED NAME OF INSTRUCTOR:
_11. Ann Bersbach
12. SIGNATUf E OF C TIRED OP T APPRENTICE: 13. PRINTED NAME 4 F CERTIFIED OPERATOR/APPRENTICE:
ArTwj is(-4RT C�iA F)tj
14. CONTINUING E E6ffH0URS ARE TO BE APPLIED TO:
Operator certification /apprentice number: Class: Expiration date:
WWC)1799 (,,J3
Operator certification /apprentice number: Class: Expiration date:
Certificate of Completion Approved Environment, Inc. Page 1 of 1
Approved Environment, Inc.
P.O. Box 42744
Indianapolis, [N 46242
1- 877 241 -9858
Email: SupportC&approvedce.com
Certificate of Completion
Courses are approved in the following states: Indiana, Illinois, Ohio, Alabama. Delaware, South
Carolina, North Carolina, V(aryland, Kentucky and Ontario, Canada.
Name: Alton Chafin
Address: 12747 Touchdown Dr., Fishers, In 46037
Course Title: Primary Treatment
Course Value: 1 Contact Hour
Approval Number: IN WWTI I -5905 TO1 -G00, PWST11 -4186, OH OEPA- S296785-
OM, NC CEO 1140414, MD 3464- 05 -06, KY 10305
Date: 5/22/2012
Approximate Time Spent Taking the Course: 60 minutes.
Operator Certification License Number: WWO17998
Operator Class Level: 3
License Expiration Date: 06/30/2012
l
Operator Signature:
Training Provider Signature:
Ann Bersbach, Approved Environment, Inc.
Copyright 2002, Approved Environment, Inc., Indianapolis, Indiana
https:// www. approvedce. com/ onlineCEUs /ceuCertificateOfCompletion .asp 5/22/2012
VOUCHER 125037 WARRANT ALLOWED
T9970 IN SUM OF
CHAFIN, ALTON B.
WASTEWATER PLANT
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
BART 01- 7042 -06 $100.00
Voucher Total $100.00
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
T9970
CHAFIN, ALTON B. Purchase Order No.
WASTEWATER PLANT Terms
Due Date 5/25/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/25/2012 BART $100.00
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
Date dVcer