219792 05/07/2013 a CI4 CITY OF CARMEL, INDIANA VENDOR: 172645 Page 1 of 1
ONE CIVIC SQUARE BRETT A KEITH
} CARMEL, INDIANA 46032 CHECK AMOUNT: $150.00
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CHECK NUMBER: 219792
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 150 . 00 ORGANIZATION & MEMBER
AMERICAN POLYGRAPH ASSOC.
P.O. BOX 8037 DATE
CHATTANOOGA, TN 4i�i2o13
37414-0037
TO
Breu Keith Receipt
ENOT PAY
www.polygraph.org CHECK NO. PAYMENT MET... PROJECT
DESCRIPTION RATE AMOUNT
Membership Renewal-Paid 150.00 150.00
Total $1 x0.00
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L BRETT A KEITH 1
4304 WORCHESTER CT CARDMEMBER SERVICE
CAfiMEt IN 46033 7789 PO BOX 94014
PALATINE IL 60094-4014
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9 0 Manage your account online: Customer Service Additional contact .t�
(OdOM www.chase.com/freedo 1-800-524-3880 information on back�-!r
ACCOUNT SUMMARY PAYMENT INS®RMATI®N
Account Number: New Balance
Payment Due Date
Previous Balance Minimum Payment Due
Payment,Credits
Purchases Late Payment Warning: If we do not receive your minimum
payment by the date listed above,you may have to pay a late fee of
Cash Advances up to$35.00 and your APR's will be subject to increase to a
Balance Transfers maximum Penalty APR of 29.99%.
Fees Charged Minimum Payment Warning: If you make only the minimum
Interest Charged payment each period,you will pay more in interest and it will take
you longer to pay off your balance. For example:
New Balance
Opening/Closing Date 03/27/13-04!26/13 If you make no You will pay off the And you will end up
additional charges balance shown on paying an estimated
Credit Access Line using this card and this statement in total of...
Available Credit each month you about...
pay...
Cash Access Line
Available for Cash Only the minimum
payment
` (Saving
It you would like information about credit counseling services,call
1-866-797-2885.
CHASE F=REEDOM: ULTIMATE REWARDSO SUMMARY
Previous points balance Redeeming your points for cash back is easy!
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ACCOUNT ACTIVITY
Date of
Transaction Merchant Name or Transaction Description $Amount
PAYMENTS AND OTHER CREDITS
04/03 Payment Thank You Bill Pay Service
PURCHASES
03/27
03/28 AMERICAN POLYGRAPH ASS 800-2728037 NV i50.0�
03/27
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 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))
04/02/13 membership dues $150.00
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
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Brett A. Keith
IN SUM OF $
$150.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1110 43-553.00 $150.00
I hereby certify that the attached invoice(s), or
I
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
Wednesday, May 01,2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund