237622 09/30/14 0��+,F. CITY OF CARMEL, INDIANA VENDOR: 00351684
® ONE CIVIC SQUARE CLERK OF THE COURTS-ANNUAL FEES CHECK AMOUNT: $.....**180.00*
f. ,=a CARMEL, INDIANA 46032 P 0 BOX 6069 DEPT 179 CHECK NUMBER: 237622
9M�«ON�` INDIANAPOLIS IN 46206-6069 CHECK DATE: 09/30/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4355300 HANEY 180.00 ORGANIZATION & MEMBER
a ppealsderk.Kgov
Payment Acknowledgment
Thank you for initiating your payment! Please print two (2) copies of this page --submit
one copy with your payment and keep the other copy for your records.
For payment by check:Write your confirmation number(see below) on your check,
and then mail or deliver your check, along with a printed copy of this Payment
Acknowledgement, to:
- - -- -_ - -Clerk--of-the-Courts-Annual Fees
P.O. Box 6069— Dept. 179
Indianapolis, IN 46206-6069
Your payment will be recorded as of the postmark date on the envelope containing your full
payment. Late fees will be due if full payment is not timely submitted.
For payment in cash:-Cash payments may be personally delivered with a copy of this
Payment Acknowledgement between 8:30 a.m. -4:30 p.m. on regular business days to
the following location:
Clerk of the Courts -Annual Fees
402 W. Washington St., Rm. W062
Indianapolis, IN 46204
Confirmation #:13249
Billing Information -
Confirmed: 9/23/2014
Douglas Haney (11207-49)
AnnualFee .............................................. $180.00
Subtotal: $180.00
Grand Total: $180.00
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Payment Acknowledgment
Your payment has been initiated.Please print this page twice:one copy for your records and one to turn in with your payment.
Failure to include a copy of this Payment Acknowledgment with your payment may result in your payment not being credited to
your account.A copy of this information has been emailed to you.
Confirmation #: 13249
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Pending Fees (Transaction processed at 1:33:40 PM ECT, 9/23/2014)
Douglas Haney(11207-49) Annual Fee $180.00
Total Due $180.00
Instructions
For payment by check IMPORTANT:Write your confirmation number on the memo line of
Write your confirmation number(see below)on your check,and then Your check.
mail or deliver your check,along with a printed copy of this
Payment Acknowledgment,to: Sohn Q.Public
713 Wain street
S2rnewhere Indiana 46294 Date
Clerk of the Coutts-Annual Fees (31:)565-5555
P.O.Box 6069—Dept. 179 PA�to.lhe Clerk of the Courts-Annual Fees
Indianapolis, IN 46206-6069
Your payment will be recorded as of the postmark date on the
envelope containing your full payment.Late fees will be due if full Meff= Confirmation 9
payment is not timely submitted.
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For payment in cash '
Cash payments may be personally delivered,in exact change only,
with a copy of this Payment Acknowledgment between 8:30 a.m.-
4:30 p.m.on regular business days to the following location:
Clerk of the Courts-Annual Fees
402 W.Washington St., Rm.W062
Indianapolis, IN 46204
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appealscleik, g•
Payment Acknowledgment
Thank you for initiating your payment! Please print two (2) copies of this page --submit
one copy with your payment and keep the other copy for your records.
For payment by check:Write your confirmation number(see below) on your check,
and then mail or deliver your check, along with a printed copy of this Payment
Acknowledgement,to:
Clerk-of-the'Courts --Annual Fees
P.O. Box 6069— Dept. 179
Indianapolis, IN 46206-6069
Your payment will be recorded as of the postmark date on the envelope containing your full
payment. Late fees will be due if full payment is not timely submitted.
For payment in cash: Cash payments may be personally delivered with a copy of this
Payment Acknowledgement between 8:30 a.m. -4:30 p.m. on regular business days to
the following location:
Clerk of the Courts -Annual Fees
402 W. Washington St., Rm. W062
Indianapolis, IN 46204
Confirmation #:13249
- —Billing Information - -
Confirmed: 9/23/2014
Douglas Haney (11207-49)
Annual Fee .............................................. $180.00
Subtotal: $180.00
Grand Total: $180.00
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.199
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
Clerk of Courts - Annual Fees
Purchase Order No.
P. O. Box 6069 - Dept 179
Terms
Indianapolis, Indiana 46206-6069 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9193114 1394-9 Ann,lal Fee - no,icilas Haney
0...
Total
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in ac�corr--
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
r''eF'( of the G„' r-t IN SUM OF $
PO Box 6069 - Dept. 179
Indianapolis, IN 46206-6069
$ $180.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Law
4355300 - Organization & Member Dues
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
1180 1324 435-5300 $180.00 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
i
201
1
I
Cost distribution ledger classification if
Titl
claim paid motor vehicle highway fund