216031 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 00351734 Page 1 of 1
ONE CIVIC SQUARE FIREHOUSE MAGAZINE
0 CARMEL, INDIANA 46032 PO BOX 3258 CHECK AMOUNT: $59.90
NORTHBROOK IL 60065 CHECK NUMBER: 216031
CHECK DATE: 1/912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 968824 29 . 95 SUBSCRIPTIONS
1120 4355200 968826 29 . 95 SUBSCRIPTIONS
® . CIO
PO BOX 3258,NORTHBROOK,IL 60065-3258
❑Department Address ❑Home Address(Please check one)
Please make any name,title or address changes as necessary. ` f .;}fi� ?
a
DENISE SNYDER
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL, IN 46032
-Y
H YY.
Ship to: =:
968826 RNLPD1
CARMEL FIRE DEPT STA 45
10701 N COLLEGE AVE
INDIANAPOLIS, IN 46280
o `$,29:95:r.
wish to suppoit the Heroism ProgramX
PTO � ,
TA��SU..BSCRIPTION�;';p1us Heroism �:$ x•�,,"
Subsci ber Title/Rank check orie ont T e of Department(check one 61
❑Payment Enclosed ❑ 01. Fire Chief ❑ 01. Volunteer/Paid-on-Call
Charge to:' ❑ �� (� ❑ `: ®:, ❑Bill Me ❑ 02. Asst.or Deputy Fire Chief ❑ 02. Paid
` -' Ej 03. Batt]./Div./Distr.Chief 0 03. Combination Paid/Volunteer
❑ 04. Commissioner ❑ 07. Other Fire Department
Credit Card p
❑ b5. President/OwnerNP ❑ 04. Industrial/Institutional
Signature(Required): Date: ❑ 06. Secretary/Treasurer ❑ 05. Military/Federal
r'-n7_ ntho..ct !1,tr�oi��Fe�ln.�E.crarn_ ---i i_9u flt ar_rcncrttvl• �.
°Nafie L"rie"ase' rit�f ,ire t`._-_. ..___. ._- .� 9-S. h_.( ." - - --
Title I Rank:
- and Local incl.City Mgrs.
_ ❑ 08. Fire Marshal
-•,ftm'` ,f t Po ulation Served ti :De ailment
�t I A ❑ 09. Trainin Officer/Instructor P. Y. P . ... ..
Address: ❑ 10. Captain/Commander/Lt. ❑ 01. Under 2,500
�.• ��•°a *:;�.�
❑ 11. EMS Director/Coordinator ❑ 02. 2,501 -10,000
State I Province::';=:_',..x:'= 12. Firefighter ❑ 03. 10,001
25 000
Zip I Postal Code: Country ❑ 13. Paramedic/EMT ❑ 04. 25,001-75,000
e:
y,_d ntry: ❑ 14. Engineer ❑ 05. 75,001 -150,000
Phiine:
�=��>�• - 06. Over 1
98. Other i L 50000
:.� ❑ sec ,
E-mail(Required): Function:
y,.::,,, .t,,;:,;:,.: • .r 4 r ,;. .;r= ; =•" ❑01. Management ❑05.Investigation ❑09.EMS
,Would you,like�to�receive Product and-r-vice information from our,ini t-y',..ners wa e,maU t
u. - -- --•• . �s ❑02. Training ❑06.Maintenance ❑10.Hazmat
t t i ❑03. Prevention ❑07:Communication ❑11.Rescue
❑04. Suppression ❑08.Public Education ❑12.Other:
1 1
Priority Code:.STDRNL
o. SM i CIS P i�(ION RENEWAL/WVOOC E
PO BOX 3258,NORTHBROOK,IL 60065-3258
Department
Pleas make any amre,title o address Address check one)
changes as necessary.
Please }4 FINµ F vim ^
.silt ! g '
DENISE SNYDER
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL, IN 46032 „
Masi,7__'
s:.
.
Ship to:
-10'2012._.
968824 RNLPDI
CARMEL FIRE DEPT STA 41
2 CIVIC SQUARE
CARMEL, IN 46032 ''_
i wish to support,the Heroismlprogram=-`-,,, ,
TOTAL SUBSCRIPTION,p�us.Heroism'
1 1 `� Subsc'r ber.Title`/Rank(cfleck one only): Type of Department(check'one only):
❑Payment Enclosed ru ❑ 01. Fire Chief ❑ Of'VolA6er/Paid-on-Call
Charge to: ❑ ❑ ❑ ®: ❑Bill Me ❑ 02. Asst.or Deputy Fire Chief ❑ 02. Paid
❑ 03. Battl./Div./Distr.Chief 03. Combination Paid/Volunteer
Commissioner
4
❑ 0 . i
Credit Card El 07. Other Fire Department
❑ 05. PresidenVOwnerNP u 04. Industrial/Institutional
Signature(Required): Date: ❑ 06. Secretary/Treasurer ❑ 05. Military/Federal
-'f _ i ''" '` -❑-G7. GiheP U�iriii inls �eacrSi State- u"9o-'Cuicr'`�c^c>
,Name,(Please`print):`
Title I Rank: and Local Incl.City Mgrs.
❑ 08: Fire Marshal
,'ti^ ,„":':, ,:. c-S=N N;nYi`3" -•7,,-.�,`t:.'.^`{rar:: :,<:w,.::`
De t I A?enc:° '%1: °j-•>. ...;;:° • *- fY tx Y; =: :-,x,f•F r ❑ 09. Training Officer/Instructor populatidn Served by.Departm'ent:.
Address: ❑ 10. Captain/Commander/Lt. ❑ 01. Under 2,500'
} ,,a m r ❑ 11. EMS Director/Coordinator ❑ 02. 2,501 -10,000
.City:;; w ,;' _. a°:+ Stateel Proviricem ❑ 12. Firefighter ❑ 03. 10,001 25,000
Zip I Postal Code: Country: ❑ 13. Paramedic/EMT ❑ 04. 25,001 -75,000
:: ;.;; ;s=.:"t .,;' ,�.w: ,.:-,::<:: -:'u;• ❑ 14. Engineer ❑ 05. 75,001-150,000
Phone y,w El 98: Other(specify) ❑ 06. Over 150,000
...
E-mail(Required): Functiori:
,,-r-y y, ❑01. Management ❑05.Investigation ❑09.EMS
❑ 'Would youJike to"receive Product and Seivice,information fromfour,in5ustry"Partners via a mail: :>w
. _....:..:r... 4.,_-. ❑02. Training ❑06.Maintenance ❑10.Hazmat
i I ❑03. Prevention ❑07°Communication ❑11.Rescue
❑04. Suppression ❑08.Public Education ❑12.Other:
1 1
Priority Code:.Sf6kNL
VOUCHER NO. WARRANT NO.
ALLOWED 20
Firehouse Magazine
IN SUM OF $
P.O. Box 3258
Northbrook, IL 60065
$59.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 968824 43-552.00 $29.95 1 hereby certify that the attached invoice(s), or
1120 968826 43-552.00 $29.95 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
JAN -7 2013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Irescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
968824 Sta. 41 $29.95
968826 Sta. 45 $29.95
1 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