HomeMy WebLinkAbout238850 11/05/14 m..4�gy
CITY OF CARMEL, INDIANA VENDOR: 363546
`.
ONE CIVIC SQUARE INDIANA STATE CHEMIST CHECK AMOUNT: $********45.00*
.;;
?4 CARMEL, INDIANA 46032 OFFICE OF INDIANA STATE CHEMIST CHECK NUMBER: 238850
y�roN PURDUE UNIVERSITY,175 S UNIV.ST CHECK DATE: 11/05/14
WEST LAFAYETTE IN 47907-2063
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 N35567. 45.00 ORGANIZATION & MEMBER
Page 1
2015 INDIANA PESTICIDE COMMERCIAL APPLICATOR RENEWAL APPLICATION
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
4
CARMEL IN 46033-1212
Current Phone: (317)846-7431 Ext.
Current Fax:
Business e-mail: BHIGGINS@CARMEL.IN.GOV
Submit the Renewal Application In the enclosed envelope before December 31,2014.Those
applications postmarked after December 31,by law,require an additional 100%late fee penalty.
Certification in each category is valid for a five(5)year period.
NOTE: A license and technician registration is renewed each year prior to December 31.
` License Number= N35667 FEE=$45.00 RENEW DO NOT RENEW
ROBERT DAVID HIGGINS Personal e-mail: BHIGGINS@CARMEL.IN.GOV
Category 3B 20 CCHs earned out of 20 required Category Expires 12/31/2017
[Total Fee Due: $45.0
Submit the Renewal Application in the enclosed envelope before December 31,2014.Those
applications postmarked after December 31,by law,require an additional 100%late fee penalty.
Send to: Office of Indiana State Chemist,Purdue University,175 S.University St.,West Lafayette,IN 47907-2063
Make check payable: Indiana State Chemist
I hereby swear and affirm that the list being submitted is a true and accurate record of the current certified employees working
at this business location.I also acknowledge that failure to provide accurate information on this application
form constitutes a violation of the Indiana Pesticide Use and Application Law(IC 15.3-3.6 Section 65(11)).
Irl
Printed Name Job title of person signing
/0
Signature Date
**** FOR STATE CHEMIST OFFICE USE ONLY****
APPROVED DATE
Check No Amount Entered Under
License# GN30022 Posted Account#
RT
PAL
FAL Amount
[Total Fee Due: $45.0
VOUCHER NO. WARRANT NO. P
Indiana State Chemist ALLOWED 20
ffice of IN St Chemist, Purdue Univ.
IN SUM OF$
75S. University Street F
est Lafatette, IN 47907-2063 3�0N
$45.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
O#/Dept.I INVOICE NO. ACCT#IrITLE AMOUNT Board Members _
1207 N35567 43-553.00 $45.00 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
Friday, October 31, 2014
Director, Brookshire GI Club
Title
Cost distribution ledger classification if I,
claim paid motor vehicle highway fund
escribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
hom, 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))
10/31/14 N35567 2015 Dues $45.00
hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
ith IC 5-11-10-1.6
20
Clerk-Treasurer