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Home My WebLink About232155 05/07/14 (9, CITY OF CARMEL, INDIANA VENDOR: 00351239 ONE CIVIC SQUARE BUREAU OF MOTOR VEHICLES CHECKAMOUNT: $********15.00* CARMEL, INDIANA 46032 100 N SENATE AVENUE CHECK NUMBER: 232155 ROOM N415 CHECK DATE: 05/07/14 INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4358300 CK REQUEST 15.00 OTHER FEES & LICENSES Cannel o Clay Parks&Recreation CHECK REQUEST Date: J�b b t/ Check payable to: Name: 1 Fa a Address: I DO 121 3-ena.L' R(k;- hy S- City, State, Zip Mail check to payee Return check to requestor Check Amount: $ Date Required: Check needed for: V:k un, �ckl �s 9 e A To be paid from: PO#(if applicable) Budget account-GL# l[�,�5�"((� �1 ��S3Lb0 J Budget Line Description U, A-�f, 02-�I,� Invoice(s)and Purchase Order(if required)MUST be attached. Requested by(print): Mr, Yoe- Requestedby (signature): LM Approved by (signature of Division Manager): on this date Xy 61// Form revised 7-7-08 Shared/Administrative/Forms/Staff forms/Check Request(rev 7-7-08) STATE OF INDIANA BMV Michael R. Pence, Governor Donald M. Snemis, Commissioner MUNICIPAL CORPORATION AND LAW ENFORCEMENT TITLE AND REGISTRATION APPLICATION CHECKLIST Title and registration applications for Municipal Corporations and Law Enforcement are processed by the BMV Municipal Processing Department to improve the security and efficiency of these transactions. Prior to submitting each application, please verify that all required information is included. Contact (888) 692-6841 with any questions. Title Application Requirements Completed and signed Application for Certificate of Title—State Form 44049 Original Certificate of Title or Certificate of Origin - ❑ Physical Inspection of a Vehicle or Watercraft—State Form 39530. Required for vehicles purchased outside of Indiana. Odometer Disclosure Statement—State Form 43230 (if odometer statement is not completed on the certificate of title or certificate of origin). Trailers and motor vehicles over 16,000 lbs exempt. ST108E -Certificate of Gross Retail or Use Tax Exemption—State Form 48841 $15 title application fee. Fees are payable by credit card (MasterCard or Visa), check, electronic check, or money order. A $21.00 delinquent fee will be assessed on packets received 31 days after the purchase date listed on the Certificate of Title or Certificate of Origin. Registration Application Requirements ❑ Application for New and/or Transferred License Plates for Municipal Corporations and Law Enforcement—State Form 53565 ❑ Copy of Certificate of Title or Application for Certificate of Title—State Form 44049 (if already titled to applicant) ❑ Copy of the lease agreement or Statement of Existing Lease Agreement—State Form 12787 if the vehicle is being leased from a leasing company. ❑ Safety Inspection completed by ISP for all municipally owned school buses If the Bureau of Motor Vehicles determines that sufficient credible evidence exists to substantiate the applicant's claim of ownership, a title and registration will be issued. For your convenience, the required forms are included with this checklist. The forms are also available at myBMV.com. Mail the completed packet to: Central Office Municipal Processing 100 North Senate Avenue, Room N415 Indianapolis, IN 46204 Note: Include this checklist on the top of your application with contact information provided below. If all required documents are not submitted or information is incomplete the entire application will be returned. Print Name Phone Number Email (optional) An Equal Opportunity Employer APPLICATION FOR NEW AND/OR TRANSFERRED •k.�..•, BUREAU OF MOTOR VEHICLES . . '' LICENSE PLATES FOR MUNICIPAL CORPORATIONS Municipal Processing ;` � 100 North Senate Avenue AND LAW ENFORCEMENT �•%` —•� State Form 53565(R3 16-13) Room N415 7e;e Indianapolis,IN 46204 INDIANA BUREAU OF MOTOR VEHICLES INSTRUCTIONS 1. Complete in blue or black ink or print form. 2. Complete all information in sections 1, 2,3, and 4,as applicable and mail to the address listed above. 3. The application must be accompanied by a copy of each vehicle title, title application,or lease agreement. 4. Choose one of the following:a permanent license plate type that is reflective of your entity;a standard passenger license plate,or indicate other license plate type desired. 5.A safety inspection must be completed by the Indiana State Police for all school bus plate requests. SECTION 1'.APPLICANT'IN'FORMATION Official name of entity that owns or leases the vehicle(s) State Board of Accounts number Federal Identification Number Entity's Executive Officer's name and title Contact Telephone number Email Address F g e, e 1 s CC-VLA r ( 6)7 ) 5 r(?)—qc) ( -7 1 CAA!t 0-031'—, Entity street address(number and street) LI t � � � I t c��rS�-�� - city State IZIP Code County Township IN L,t,C+52 /Aaf j Lr1 S CTION'l VEHICLE INFORMATION . (List the following information for-each vehicle,attach additional sheets_if necessary), 1 VEHICLE IDENTIFICATION NUMBER : (Please enter in spaces below. Purchase or lease date(mm/dd/yyyy) 5 E10 4 1 E-1 x 10z I i I�q I ) 0Ll//-7/z0 i L Color Type Make Model Year Gross Vehicle Weight 1 K, -C; I(3C.0 Z()Z q (if applicable) Description of official business for which the entity will use the vehicle Financial Responsibility(Source of self-insurance;or Insurance Company Name and (LEA's should include here if tactical or non-tactical vehicle.) Policy number) 14 19J, L1 R L.0 F l 3 The application is for(check one) License Plate Tye: check one City Police —Sheriff Municipal _School Bus —State Owned University —Driver Education New License Plate / Or you may choose one of the following: v J� Transfer an Existing License Plate: 6 r7-S 9 (p —Passenger —Other: late number) (enter plate type) 2 VEHICLE IDENTIFICATION NUMBER: (Please enter in spaces below.) Purchase or lease date(mm/dd/yyyy) Color Type Make Model Year Gross Vehicle Weight " (if applicable) Description of official business for which the entity will use the vehicle Financial Responsibility(Source of self-insurance;or Insurance Company Name and (LEA's should include here if tactical or non-tactical vehicle.) Policy number) The application is for(check one) License Plate Type: check one City Police —Sheriff —Municipal _School Bus —State Owned University —Driver Education New License Plate Or you may choose one of the following: _Transfer an Existing License Plate: (plate number) —Passenger —Other: (enterplate type) 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. 100351239 Bureau of Motor Vehicles Terms 100 N. Senate Ave. Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 4/30/14 Ck Request Parks vehicle plate transfer fee $ 15.00 Total $ 15.00 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. '00351239 Bureau of Motor Vehicles Allowed 20 100 N. Senate Ave. Indianapolis, IN 46204 In Sum of$ $ 15.00 i ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO#or INVOICE NO. ACCT#[TITLE AMOUNT Board Members Dept# 1125 Ck Request 4358300 $ 15.00 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 Ido 1-May 2014 �Il 1/1 l Signature $ 15.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund