220663 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 155400 Page 1 of 1
ONE CIVIC SQUARE INDIANA STATE BAR ASSOC CHECK AMOUNT: $320.00
CARMEL, INDIANA 46032 ONE INDIANA SQUARE,SUITE 530
INDIANAPOLIS IN 46204-2199 CHECK NUMBER: 220663
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4355300 320 . 00 ORGANIZATION & MEMBER
* * INDIANA STATE BAR ASSOCIATION METHOD OF PAYMENT(CHECK ONE BOX)
DUES NOTICE ❑ VISA ❑ MASTERCARD ❑ DISCOVER
® July 1, 2013 - June 30, 2014
® � CARD NUMBER
ONE INDIANA SQUARE, SUITE 530 ❑❑❑❑❑❑❑1:11:11:11:11:1❑❑❑❑
INDIANAPOLIS, IN 46204-2199 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
317-639-5465 800-266-2581 Fax: 317-266-2588
e-mail: isbaadmin @inbar.org EXP.DATE
YOU MAY PAY DUES ONLINE & UPDATE SIGNATURE ❑
YOUR MEMBERSHIP INFORMATION Verification Code
UNTIL 9-30-13: www.inbar.or CHECK
g , payable to:Indiana State Bar Association
Automatic Credit Card Renewal Option: . By initialing here, your
23811 dues will automatically be charged to your credit card July 1st of each year
at the appropriate dues rate in existence for the ISBA at the time of renewal.
Douglas C. Haney To cancel your automatic renewal, members must notify the ISBA 10 days
City of Carmel prior to the renewal date.
One Civic Square
Carmel, IN 46032
Regular Dues(6 yrs or over) 280.00
Governmental Practice Section 15.00
ADDRESS,E-MAIL,PHONE&FAX CORRECTIONS REQUESTED ON BACK Voluntary IBF Contributions-
ee-
CHANGES IN SECTION ENROLLMENTS: Please Voluntary BarpacCur'iiributiun r8 70-d—
indicate with an X any section you wish to add.
AGRICULTURAL LAW $20 Total
345.00
ALTERNATIVE DISPUTE RESOLUTION $20
ANIMAL LAW $15
APPELLATE PRACTICE $20
BANKRUPTCY&CREDITORS'RIGHTS $30
BUSINESS LAW $10 Amount Paid:
CONSTRUCTION&SURETY $20
CORPORATE COUNSEL $10
CRIMINAL JUSTICE $20
ELDER LAW $20
EMPLOYMENT&LABOR LAW $25
ENVIRONMENTAL LAW $25
FAMILY&JUVENILE LAW $15
GENERAL PRACTICE,SOLO&SMALL FIRM $25
GOVERNMENTAL PRACTICE $15
HEALTH LAW $15
INTELLECTUAL PROPERTY $10
INTERNATIONAL LAW $15
LAND USE&ZONING $15
LITIGATION $15
PLEADS(Prof. Legal Ed.,Admissions&Development) $20
PROBATE,TRUST&REAL PROPERTY $20
SENIOR LAWYERS $15
TAXATION $25
UTILITY LAW $20
YOUNG LAWYERS $15
(INCLUDE THIS PORTION WITH REMITTANCE.
See reverse side for important information regarding tax deductions.
1
PLEASE UPDATE YOUR E-MAIL ADDRESS, PHONE, FAX
AND OTHER DEMOGRAPHIC INFORMATION
E-MAIL ADDRESS
PHONE NUMBER FAX NUMBER
❑HOME
❑OFFICE
T Membership Dues and Section Dues are not tax deductible as charitable
=contributions, but a portion-may-be tax deductible under other provisions
CITY STATE ZIP of the Internal Revenue Code.This year, 5%of your dues were used for
lobbying expenses and may not be tax deductible.
The Indiana Bar Foundation is a 501(c)(3)organization.The$40.00 listed
FIRM,EMPLOYER NAME OR PUBLIC OFFICE is a voluntary charitable contribution.
BARPAC is a political action committee.The$10.00 contribution listed is
voluntary and not tax deductible.
AREA OF PRACTICE
$5.00 is allocated from your dues payment for your Res Gestae
subscription.
PLEASE CHECK THE APPROPRIATE BOXES.
a.❑FEMALE b.❑MALE
1.❑AFRICAN AMERICAN 2.❑AMERICAN INDIAN 3.0 ASIAN
4.❑CAUCASIAN 5.❑ HISPANIC 61]OTHER
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 11 PURCHASE ORDER NUMBER
�-� FEDERAL EXCISE TAX EXEMPT !j
I- 35-60000972 ;.5 3 '7 7
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
� " ,�!f�/: -CD�r✓ SHIP
VENDOR
b TO
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION f /t UNIT PRICE EXTENSION
f y' C..�'f�'4,t•,rj�./�,•�r 1 !(,�.�C-�-�'� �0� ,�tl�/��% � �.c!s�-�
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Send Invoice To: "
t
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT }% 3pZL"r C�G3
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. (� `
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
3 2 ( CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.__-__.WARRANT NO.-._A_`.
ALLOWED 20
IN THE SUM OF$
.30
clil
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
D' 06 materials or services itemized thereon for
which charge is made were ordered and
received except
oZ 20/__3
Title
+ I
Cost distribution ledger classification if
claim paid motor vehicle highway fund