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Home My WebLink About222593 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 362215 Page 1 of 1 ONE CIVIC SQUARE BROOKE TAFLINGER CARMEL, INDIANA 46032 11008 BROADWAY ST CHECK AMOUNT: $80.00 INDPLS IN 46280 CHECK NUMBER: 222593 «ON 0 CHECK DATE: 7/30/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4355300 80 . 00 ORGANIZATION & MEMBER Carmel • Clay Parks&Recreati®n Employee Expense Reimbursement Request t Date of Fund Account Account Receipt Vendor listed on receipt # ii Line# Budget Description Amount Purpose of Expense Z� Brooke Taflinger 6001` 43505300 IDr 4 w4-n6.Aw. snw NCTRC Annual Fee All receipts should be attached in the same order as listed above. No sales tax will be reimbursed. TOTAL: $80.00 f . Employee Name(print) Brooke Taflinger L - 9 2013 Address 11008 Broadway St. Check JU FI payable to: City, St, Zip Indianapolis, Ln 46280 - -- Signature: Approved by92 Date: 6/28/2013 Date: �� Business Services Division,Revised 7-7-08 FILE: Shared\Administrative\Forms\Staff Forms\Employee Exp Reimb Request ..�� i t �� :��_� 6 e-Events : Purchase Confirniation Summary Page 1 of l Welcome, Brooke N.Taflinger (ID: 53281) Home Logout I Sign up I Help I Contact Us Member Data I Member Services I I Vote Online Personal Brooke Taflinger Purchase Confirmation Summary ID: 53281 Security Confirmation # 239511 Total charge to credit card: $80.00 Payment Date 06/28/2013 Home Credit card used: VIS CC #: ************5579 -Thank you for paying online. Your payment of$80.00 amount from Total Payment Due on 06/28/2013 has been processed electronically and will be reflected on your bank statement. Payment will be posted to your NCTRC account within 2-3 business days. If you need a verification letter to confirm your status, please contact NCTRC. Item Cost Billing Mandatory Dues Total $ 80.00 Total $ 80.00 Print this page webmaster I information I https://www.netrc.org/source/Meetings/eMeetingRosterDetai1.cfm?section=unknown&ID=... 6/28/2013 Brooke Taflinger From: rmcneal @nctrc.org Sent: Friday, June 28, 2013 2:08 PM To: rmcneal @nctrc.org; Brooke Taflinger Subject: Online CTRS Annual Maintenance Application Received Application received for Brooke N. Taflinger (ID: 5328 1) on 06/28/2013. Your Information Section First Name: Brooke Middle Name: N. Last Name: Taflinger Address 1: 11008 Broadway Ave. City: Indianapolis State: IN Zip: 46280 Work Phone: (317) 573-5245 Home Phone: (303) 880-8073 Fax: (317) 573-5254 Email: btaflinger(a),carmelclayparks.com Your Agency Section Agency: Carmel Clay Parks and Recreation Title: Inclusion Supervisor Address 1: 1235 Central Parks Dr. East City: Carmle State: IN Zip: 46032 I Past Year of Employment Section Dates of Employment: 10/08 to Current Employment Status over Past Year: I work full-time in TR (at least 32 hours per week). Position: TherapistSupervisor Confidentiality Section Confidentiality Release: Yes i Identification Information For Security Purposes Name of Undergraduate Institution: Indiana University Eligibility Section #1. Do you have a disabling condition or addiction to any substance that could impair competent and objective professional performance of therapeutic recreation services and/or jeopardize public health and safety?: No #2. At any time, have you been subject to an investigation or disciplinary action by a health care organization, professional association, governmental entity or regulatory or licensing agency or authority?: No #3. Have you ever been convicted, found or entered a plea of guilty or nolo contendere, or are you presently being investigated or charged with any felony or misdemeanor directly relating to therapeutic recreation services or public health and safety?: No Eligibility Section I acknowledge and affirm that I have carefully read and understand NCTRC's standards, rules and requirements and that 1 agree to abide by these terms and to be bound by all of the provisions of the Declarations above.: Yes z ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 362215 Taflinger, Brooke Terms 11008 Broadway Ave Indianapolis, IN 46280 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO # Amount 6/28/13 Reimb. NCTRC Annual fee $ 80.00 I Mileage 4/18/11 Total—I $ 80.00 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 Voucher No. Warrant No. 362215 Taflinger, Brooke Allowed 20 11008 Broadway Ave Indianapolis, IN 46280 In Sum of$ $ 80.00 ON ACCOUNT OF APPROPRIATION FOR 109 - Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 Reimb. 4355300 $ 80.00 1 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 25-Jul 2013 Signature $ 80.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund