216428 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 152500 Page 1 of 1
ONE CIVIC SQUARE INDIANA LEAGUE OF MUNICIPAL CLER6HECK AMOUNT: $187.50
CARMEL, INDIANA 46032 TREASURER'S
200 S MERIDIAN STREET#340 CHECK NUMBER: 216428
INDIANAPOLIS IN 46225
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4355300 DUES 187 . 50 CORDRAY/SHEEKS
INDIANA LEAGUE
of
MUNICIVAL 2013 ILMCT ANNUAL DUES NOTICE
Claim and Invoice
'WE SEARCH I OR
r Due Date: 2013 Dues for all Classes of Membership due on or before March 1, 2013
J-3 l
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 class of
membership and dues schedule which applies.
Active Members:
(Clerk-Treasurer, Clerk, Controller)
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: c�,
Title: Clerk-Treasurer ❑ Clerk ❑ Controller
Certification (Check all that apply): AMC ❑ CMC ❑ MMC ❑ CPFA
Name of Municipality: ea_,v�l County - 444-"Jo l�
Office Address: 01 , 61 Ut y,=�qo
City/Town/Zip: 5-,r
Office Phone: � � 'a 'f�G Fax:
Office e-mail: C� �i`C�' i'��__ A)' -
Home Address: City/Town/Zip:
-Name Phone: j( .a D�^ [ O( U
r
Financial computer software used SOFA �F�IE i2G ti
(This question is being asked to assist the Me for C mmittee in placing people with like software.)
ILMCT Membership Benefits Include:
• Notice of League events (includes training and professional development opportunities)
• A subscription to the QUEST, the ILMCT official print and digital newsletter
• In some cases, discounts for League sponsored events
• Access to League website —www.ILMCT.org
• Access to League Listserve
• Membership Roster
i
Associate Members: $60.00 ❑
(Staff of an active member of the league): /�ii
• Associate Member Name: [n &�.F-
�� s Title:
Address: City/Town/Zip: Jc�
• Associate Member Name: Title:
Address: City/Town/Zip:
(Please copy form for additional Associate Members)
Associate Members: $60.00 ❑
(Retired or former active member):
• Associate Member Name: Title:
Address: City/Town/Zip:
_°--Associate Member Name: Title:
Address: City/Town/Zip:
(Please copy form for additional Associate Members)
Affiliate Members: $60.00 ❑
(Any person in municipal government (elected or appointed) who is not already qualified for another
membership class)
• Affiliate Member Name: Title:
Address: City/Town/Zip:
• Affiliate Member Name: Title:
Address: City/Town/Zip:
(Please copy form for additional Affiliate Members)
Checks to be made payable to:
TOTAL ACTIVE MEMBER $ Indiana League of Municipal Clerks
TOTAL ASSOCIATE MEMBER $ and Treasurers or ILMCT
TOTAL AFFILIATE MEMBER $ Please remit payment to.
ILNICT - —
G 200 South Meridian Street, Suite 340
TOTAL AMOUNT ENCLOSED $ // O �� Indianapolis, Indiana 46225
I 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.
ffzml WWwtzi,Secretary&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.
Payee
�7 Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Na d�a
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.
1 L� b ALLOWED 20
IN SUM OF $
lY r�&"
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
-M li3 20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund