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Home My WebLink About240402 12/16/2014 o!_Fggy CITY OF CARMEL, INDIANA VENDOR: 241763 ® CHECK AMOUNT: $*******195.28* ONE CIVIC SQUARE PETTY CASH x.. ,�a CARMEL, INDIANA 46032 C/0 LISA CHECK NUMBER: 240402 '.yy�TON�°` C/0 LISA CHECK DATE: 12/16/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 108.68 OTHER EXPENSES 651 5023990 86.60 OTHER EXPENSES PETTY CASH NUMBER DESCRIPTION • • ch, kd ��i.�1 CHARGE O ACCOUNT TOTAL Received By Approved By 9672 J -OFFICE DEPOT# 539 12917 N. Meridian St. Carmel, IN 96032 (317)571-1300 06/28/2013 13.2.1 10:29 AM STR 539 REGI TRN 6868 EMP 33399 SALE Product ID Description Tol +l 977727 CLPBRD,OD,3PK, 5.99 S Subtotal: 5.99 Total: 5.99 Cash: 20.50 CI{ANGE: (15.0,1 ): Tax Exemption Number 12603922 Shop 01-11 i rte d I.www A)Ff i cedepo t..Com WE WANT TO HEAR FROM YOU e in our online rustomer .surve�j coupon for J off your ins Prircluse of $50 or more on .;uPr ias, furnii_ and vrure. Trcl,"i.!rniy !.imi! I' coupon Per hr" .ehold uusi.nese, Visit www.officedePot.com/feedback and enter the surveu code below. Survey Code: C30V KFZD ZV4E - - iE jE'IE'JE'lE 3E'14'1f'N**3f#iE'X"lE'IF 3F jE iE iF*3E-X'*#3f iE iE 9E x 1f'!E'**i*x")l'if jt if IiIIIIIIIIIIIIIIII '`1\ \ ..__ ILII VIII IIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIII I.. 22VT5Q5PX555EMC8B Refund Methods for Returns without an Original Receipt All ink,toner and supplies being returned without an Original Receipt require valid government Identification.Items still active in our computer system will be refunded in the form of an Office Depots Merchandise Card In an amount equal to the lowest retail price during the preceding 90 days.If that amount is under$10,we will refund In cash. Office Depot reserves the right to request identification or deny any exchange or return. Catalog and Web Purchases may be returnedlexchanged in accordance with this policy by contacting 1-80D-GO-DEPOT(1-800.463-3768)or in any store. Non-Refundable:Special Order/Custom Items and Manufacturer Direct Items cannot be returned or exchanged unless damaged upon receipt.Pre-Paid Cards such as Gift Cards and Phone Cards are non-refundable,and cannot be returned or used to purchase other gift cards.Special terms and conditions are Included with each card. See Tech Depot-Services Terms and Conditions for separate return policy. Office Depot reserves the right to amend these terms at any time and to make exceptions on case-by-case basis. 100% Satisfaction Guarantee Refund Methods for Returns with Original Receipt packing sliQ or order confirmation f"Original Receipt") Our Brand Promise—Office Depot°Brand products(excluding Office Depot° Brand Ink and Toner)may be returned at any time for any reason.With Original Receipt, you will receive a full refund. Office supplies(excluding Office Depot°Brand products),with their Original Receipt and in their original,unopened condition,may be exchanged or returned for a full refund within 30 days of purchase. Ink&Toner,Including Office Depot°Brand and all national brands,with their Original Receipt and in their original,unopened condition,may be exchanged or returned with a full refund within 30 days of purchase. Technology and consumer electronic products may be exchanged or returned with their Original Receipt and In their original packaging with UPC code within 14 days of purchase.A 16%Restocking Fee will be applied If any components are missing.Opened software may be exchanged for the same item only.Please remember to remove all personal data from exchanged/returned products.Office Depot is not responsible for any personal data left in or on an exchanged/returned product. Furniture may only be exchanged or returned with Original Receipt and in new condition, unassembled,in original packaging with UPC code within 14 days of purchase. Refund Method for Returns with Original Receipt: If you paid with: Your refund will be: Cash or check written more than 10 days ago Cash Check less than 10 days ago or Office Depot° Office Depot'Gift Card Merchandise Card Credit Card or Debit Card Same Card Refund Methods for Returns without an Original Receipt All ink,toner and supplies being returned without an Original Receipt require valid government identification.Items still active in our computer system will be refunded In the form of an Office Depot®Merchandise Card in an amount equal to the lowest retail price during the preceding 90 days.If that amount Is under$10,we will refund in cash. Office Depot reserves the right to request identification or deny any exchange or return. Catalog and Web Purchases may be returnedlexchanged in accordance with this policy by contacting 1-800-GO-DEPOT(1-800-463-3768)or in any store. Non-Refundable:Special Order/Custom Items and Manufacturer Direct items cannot be returned or exchanged unless damaged upon recelpt.Pre-Paid Cards such as Gift Cards and Phone Cards are non-refundable,and cannot be returned or used to purchase other gift cards.Special terms and conditions are included with each card. See Tech Depot"Services Terms and Conditions for separate return policy. Office Depot reserves the right to amend these terms at any time and to make exceptions on case-by-case basis. 100% Satisfaction Guarantee Refund Methods for Returns with Original Recelpt packing sl :�or ord_r .confirmation(`Original Receipt") L'_1qr,a�,dProlmlse—Office Depot°Brand products(excluding Office Depot® er)may be returned at any time for any reason.With Original Receipt, full refund. /s(excluding Office Depot°Brand products),with their Original Receipt rginal,unopened condition,may be exchanged or returned for a full refund 's of purchase. PETTY CASH NUMBER DATE DESCRIPTION CHARGE TO ACCOUNT TOTAL Received By Approved By 9672 Postal �n CERTIFIED MAILT. RECEIPT (Domestic Only, ri For o t www.usps.conie ItItIiIA lAFEILw 44-94 ry information visit w .websiteur m Er Postage $ $0.46 0814 0 Certified Fee $3.10 22 �. F lm ar Return Receipt Fee Posl (Endorsement Required) $2:5553 Here v� EM Restricted Delivery Fee .9C+ -X r-q (Endorsement Required) 80.00 f CO o Total Postage&Fees $ $6.11 10 01/miz,z /, O Sent To o TJO - - NC� Ste--A o.;orPOBoxNo. -----------------/f,�/-- n "C ----------------- Cy State ZIP+4 Yb�� :rr June 2002 Certified Mail Provides: Ia�e�aa)zooz eunr'009E w�o�Sd ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined,iv fh,First-Class Mailcb`or Priority Mafie. ■ Certified Mall Is not available for any class of International mail. ■ NO INSURANCE�'6 VERAGE c'!S•PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt'Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. " ■ For an additional fee, delivery may be restricted to the addressee or addressee's authors?gd,gggent.Advise the clerk or mark the mailpiece with the endorsement"Restncted'Detivery":,•-.. ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery Information is not available on mail addressed to APOs and FPOs. DESCRIPTION OF ITEM/SERVICE PURCHASED AMOUNT �'E CHARGE • ACCOUNT TOTANO'_■ l'orkey 11111 06(;1, 2 1 S. R I gul Cashief 111noi" yoij, !,hchac"! uk!!Hy� 0!der ,*--,-,.C. x,0.99 ;1;90.99 00 To1., Ulf-) 99 beli I I - 99 CI Uel i t 'lei will-I i ;l 'Jr,, PETTY CASH NUMBER� � DATE • OF s #V", -v / o I K _ e D CHARGE TO ACCOUNT TOTAL Received By Approved By —z 9672 i S.C. PRYOR COMPANY, INC. Pryor Safe & Lock 5424 Brookville Rd. Indianapolis, IN 46219 (317) 352-1281 CUSTOMER'S ORDER NO. PHONE DATE r a 3 iy NAME C-�'"�i ADDRESS CASH C.O.D. CHARGE ON ACCT. MDSE.RET'D. PAID OUT TAX 1 -77-77 SOI BV RECEIVED BY TOTAL C PRODUCT 609 All claims and returned goods MUST be accompanied by this bill. r r , A� DESCRIPTION OF ITEM/SERVICE PURCHASED: AMOUNT • : • • NUMBER DATE DESCRIPTI • e • • (��y GFAR(a�'fCa AGC�UNT :TOTAL ' - A-9672/T-3008 RECEIVED BY APPROVED BY Hamilton County Recorder- Mary L. Clark 05/07/2014 01-08-50P Trans h 000563968 Business Date- 05/07/2014 Rei_ By: LLP 2014016705 RELEASE . 01-08-50P Subtotal- $12.00 2014016706 RELEASE 01-08-50P Subtotal- $12.00 Receipt Total- $24.00 Paid By Amount Ref # Cash '24.00 CARMEL CITY OF Rcvd From- CARMEL CITY OF Have a Wonderful Day! itt lit I t. NUMBF,R 16-0. o DATE 4//(, U • • . • I0, C7 v f S D lie z (' CHARGE TO ACCOUNfi TOTAL A-9672/T-3008 RECEIVED BY APPROVED BY,� � - Hamilton County Recorder Mary L. Clark 09/16/2014 08:52:04A Trans #2 000586601 Business Date: 09/16/2014 Pec By: SAG C14022372 COPY 08:52:04A Subtotal: $10.00 Receipt Total: $10.00 Paid By Amount Pet # Check $10.00 0000006714 LISA KEMPA Pcvd From: LISA KEMPA Have a Wonderful Day! PETTY CASH NUMBER DATE JD. DESCRIPTION OF ITEWSERVICE PURCHASED ,� CHARGE TO ACCOUNT TOTAL Received B J / Approved By J� 9672 Posta CERTIFIED . ■ (DomesticOnly, m v' 1 r 1117 IllDIANRfiOLrS IH Q4 ''` L U ) .n Postage $ $0.49 S ru M Certified Fee $3.30 Q ReturnReceipt Fee Postmark p (Endorsement Required) $2.70 Y ve� O Restricted Delivery Fee (Endorsement Required) $0.00 OTotal Postage&Fees $6.49 08/20/ m Nt"'S Ln M Sent To i �- ,A Mo.; StreeApt. 0 t or PC Box No. T A PS Form :i0 Adgust 2006 See Reverse for Instructions Certified Mail Provides: ■ A mailing receipt • A unique identifier for your mailpiece • A record of delivery kept by the Postal Service for two years Importgnt•Reminders: �:CertifiecP.Mail:may ONLY be combined with First-Class Ma11®or Priority Mail®. Cert ied Mail is:n'ot•�v'ailable forany class of international mail. r NO INSURANCE CQVERAGE.IS.PROVIDED with Certified Mail. For valuables,please corisider Insured:ot Registered Mail. ■ For an additional fee,4 Return Receipt may be requested to Provide proof of delivery.To obtain Return Receipt�seryce,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt,Requested".To receive a fee waiver for eddlu1pllicdate retuyn aeeipt,a USPS®postmark on your Certified Mail receipt is ■ For an,-Iadgftib ial+"fee;'delivery•:'may_.be restricted to the addressee or addr`ess'ee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". W If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. PS Farm 3600,August 2006(Reverse)PSN 7530-02-000-9047 PETTY CASH NUMBER DATE DESCRIPTI OF ITEM/SERVICE PURCHASED �A 0 c CHARGE TO ACCOUNT TOTAL Received By ' Approved By 9672 / Bureau of Motor Vehicles IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Customer Transaction Receipt BMU State Form 51717 (4-04) Branch: CARMEL STARS (527) Date: 5/14/13 Time: 1:11:40 pm EDT Visit ID: 184824175 Your Visit Time Today: Visit Customer: LISA L KEMPA Transaction Time 00:01:59 Total time Hrs.Min.Sec 00:01:59 Transactions Trans ID (PIN) Trans Type Trans Subtype Amount 221408953 Title- Duplicate Title Duplicate $9.00 Subtotal: $9.00 Sales/Use Tax: $0.00 Total: $9.00 Payment Method Amount Authorization Number Name CHECK $9.00 ******7987 LISA L. KEMPA Total Due: $9.00 Amount Paid: -- $9.00 Change Due: $0.00 Within 10 business days, you will receive your registration or title through the United States mail. You will be able to track the progress of your registration or title by using your PIN number listed above when calling the BMV Customer Service Center at 888-myBMV-411 (888-692-6841). If you have questions or comments, please call our Customer Service Center at 888-myBMV-411. Please help us improve our service by completing a one-minute customer satisfaction survey. Your responses are completely confidential. Visit httr)://www.in.gov/bmvsurvey/start and enter the survey code 184824175 to get started. Thank you. I Page 1 of 1 II VIII VIII VIII VIII III II VIII VIII VIII VIII VIII VIII VIII II II III 5 1 7 1 7 2 2 1 4 0 8 9 5 3 APPLICATION FOR CERTIFICATE OF TITLE - STATE OF INDIANA - BUREAU OF MOTOR VEHICLES State Form 205(R7/6-04) Approved by State Board of Account 1997 ----- —-------- I —_._.._..--------- --- ---- -- I TO BE COMPLETED BYAPOLICE OFFICER.BMV OFFICIAL ORBMV CERTIFIED DEALER SIGNEE I IANE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA- F OR OUT OF STATE TITLES.I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING; TION ENTERED ON THIS FORM IS CORRECT. I/WEUNDERSTAND VEHICLE AND FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS. ! THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER I I TUTE THE CRIME OF PERJURY. FUTHERMORE,I/WE AGREE TO INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY YR MAKE MODEL (TYPE DATE I XIABILITYARISING FROM THIS TRANSACTION. I I INSPECTOR'S PRINTED NAME&TITLE CITY X DATE: INSPECTOR'S SIGNATUREBADGEBRANCH—OR The law requiresthatyou apply for CertificateofTdlewithinthirty-one days from the date of purchase ofa motorvehicle.There is a delinquent fee of$21.00 for failure to do so.Attach Certificate of Title assigned by seller.On en- - DEALER PLATE NO. dorsed Titles,liens must be released Supporting documents surrendered with this application cannot be returned to the applF cant.State fee for applying for Title is$16.00.'in accordance with Federal Code 383. TITLE NUMBER !BRANCH NO INVOICE NO!BMV USE ONLY 1. 05141352700072 527 DUPLICATE-MV 'SOC.SEC./FEDERAL I.D.NO APPLICANT'S NAME BMV USE ONLY D 2. CITY OF CARMEL/CARMEL CLAY S 0 STREET ADDRESS CITY STATE ZIP CODE N 3. ONE CIVIC SQUARE CARMEL IN 46032 0 VEHICLE I.D.NUMBER VER YEAR VERMAKE VEH.MODEL NO. �VER ACTUAL TYPE ODOMETER T 4. 2G1WF55K929287582 2002 CHE IMP 4S 20M T FORMER TITLE NUMBER PURCHASE DATE I LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y 5. 02084068004 103/18/2002 5 No No Yes LOST E FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS 6. CITY OF CARMEL 1 CIVIC SQ N CITY STATE ZIP CODE BMV USE ONLY 7•' CARMEL IN 46032-2584 H SECOND LIEN'S NAME STREETADDRESS I 8. S CITY STATE ZIP CODE LICENSE NUMBER LICENSE FORMS BMV USE ONLY A 9. YEAR USED RG R GROSS RETAIL&USE TAX AFFIDAVIT-IME HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW E A SELLING PRICE LESS TRADE-IN / DISCOUNT AMOUNT SUBJECT TOT AMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPT 10. $ 0.00 $ . 0.00 0.00 $ 0.00 $ PLACE PARA.# 'Your Social Security number/Federal I.D.number is being requested by this agency under 24-1-8-1. Disclosure is mandatory and this document cannot be processed without it APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE - STATE OF INDIANA - BUREAU OF MOTOR VEHICLES II VIII VIII III II VIII VIII VIII VIII VIII VIII VIII VIII II 2 0 5 2 2 1 4 0 6 9 5 3 CUSTOMER COPY CARMEL RETAIL STORE CARMEL, Indiana 460329998 1740350814-0098 08/20/2014 (800)275-8777 09:30:17 AM -------------------------------------- -------------------------------------- Sales Receipt Product Sale Unit Final Description Qty Price Price INDIANAPOLIS IN 46204-2273 $0.49 Zone-1 First-Class Mail Letter 0.70 oz. Expected Delivery: Thu 08/21/14 Return Rcpt (Green $2.70 Card) @@ Certified $3.30 USPS Certified Mail #: 70140510000032609893 Issue Postage: $6,49 I - Total : $6.49 Paid by: Cash $7.00 Change Due: -$0.51 @@ For tracking or inquiries go to USPS.com or call 1-600-222-1811 . BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. a hLJI-I-y? .:,elf-service kiosks ))f.f er quick and,easy check=out.. Any Retail" hsociate'can show you'how. .Order stamps at usps.com/shop or- call 1-800-Stamp24. Go to usps.com/clicknship to print shipping ,Labels with postage; For other.:'information call 1-800-ASK-USPS. - Get your mail whet and where you want it with'a secure Post Office Box. Sign up for a box online at ,, usps:com/poboxes. Clerk:22 Al l sales f i na l • ., :i tamps and post's ti Re¢unds for guarantee?',' .er'vices a;, Thank" you for r' :us i tress .,Y• "TT'1`*%r`�-�::�:{•�::k4;.�'�•**�`%k�'%f•n..}..}.A".:j%T•�TT%1•1�T*TT - 11L�L,t' US SERVE Yw ..,'.iI'E:R Go to: https;;/postalexpei-ience.com/Pos TELL US ABOUT YOUR RECENT POSTAL EXPERIENCE YOUR OPINION:'COUNTS Customer Copy J CARMEL RETAIL'. ETAIL STORE CARMEL, Indiana 460329998 1740350814-0097 08/13/2014 (800)275-8777 02:16:04 PM = SaTes Receipt — Product Sale Unit Final Description Qty Price Price INDIANAPOLIS IN $5.60 46204-3608 Zone-1 Priority Mail 1-Day Flat Rate-Env 5.90 oz. Expected Delivery: Thu 08/14/14 USPS Tracking #: 91,14 9010 7574 2763 8284 13 Includes $50 insurance Issue Postage: $5,6.0 " Total: $5.60 Paid by: Cash $20.00 Change Due: -$14.40 @C� For tracking or inquiries go to USPS.com or call 1-800-222-1811 . BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices,, VOUCHER # 142536 WARRANT # ALLOWED 241763 IN SUM OF $ PETTY CASH -ADMIN C/O LISA i Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 121514 01-6200-07 $11.00 121514 01-6200-08 $5.49 121514 01-6360-04 $6.49 121514 01-6360-08 $21.71 121514 01-6500-04 $30.99 121514 01-6500-05 $9.00 121514 01-6750-08 $24.00 i Voucher Total $108.68 Cost distribution ledger classification if claim paid under vehicle highway fund I I Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 241763 PETTY CASH -ADMIN Purchase Order No. C/O LISA Terms Due Date 12/9/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/9/2014 121514 $108.68 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 Date 0 Riycer cio DATE • • • • • uvP/ l.�PjrJ r ........._........_............................_.._...._............._....._..............................-........................._...._.............................................................._........................................._................_.. CHARGE TQ AGC UNT i C3TAL A-9872/T-3008 RECEIVED BY APPROVED BY BED BATH & BEYOND #564 1950-6 GREYHOUND PASS CARMEL., IN. 46033 317-574-0300 00564 10 10/14/14-1351 451353 51-8875 RVN # 0056-9887-5051-1014-1900 FILTER CHARC ALLCU 1T 8627911376 OUR PRICE 8.99 FILTER CHARC ALLCU 1T 8627911376 OUR PRICE 8.99 SUBTOTAL 17.98 IN 7.00 SALES TAX 1 .2.6 TOTAL 19.24 DISCOVR-NOVUS 19.24 ACC'F#, XXXXXXXXXXXX9049 (S) EXPDT: XX/XX AU'TH#: 0H58P CHANGE .00 �II�I��I I�IIIIIII I� �I I I III�IIIIII��II�II RVN # 0056-4887-•5051-1014-1400 Go Mobile! Text OFFER to 239663 First-time subscribers set a 20% OFF one single item In-Stare or Online mobile offer. Message & Data Rates may apply. UP to 8 messages per month. Text STOP to 239663 to cancel, Text HELP to 239663 1'or info, hffp://www.bedbafhandbegond.com/fcp for Terms, Conditions, and Privacy Icl ,0 NUMBER DATE / 70 mu 2 DESCRIPTI . . -F CHARGE AC N TOTAL! A-9672/T-30 RECEIVED Y APPROVED BY-XZ�1�� Y pro NUMBER DATE D 73 F c DESCRIPTION OF ITEM/SERVICE PURCHASED AMOUNT C) CffA1�G�'TO ACCQUNT TOtAL, A-9672/T-3008 RECEIVED BY APPROVED BY .o ■ , RECEIPT r=1 (Domestic Mail Only, r insurance Coverage • •-r ru M For delivery information visit our website at www.usps.corne iN ` LIF 4 4041sdA. 2J C� ti Postage $ $0.7 0814 O fU Certified Fee C3 Return Receipt Fee �"( tmark 0 (Endorsement Requlred) +. 10 Here Restricted Delivery Fee r L (Endorsement Required) $0.00 c D fd I M Total Postage&Fees $ $6.70 047�8/ 014 M 4 Sent To a utir (/s f Sfieet,Apt:No.;--L/�- -------------------------------------------------------------- C3 / ,Lni /r%- or PO Box No. -J�O 1---f(1d q.1J lc , PL) City,State,ZIP+4 PS Form 3800,August 200. See Reverse for Instructions Certified Mail Provides: ® A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. d Certified Mail is not:available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured.or,Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSS postmark on your Certified Mail receipt is required. a For an additional,fee,.delivery,,may:,be restricted to the addressee or addressee's auttibrized'ag'ent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 -------------------------------------- --------------------------------------- CARMEL RETAIL STORE CARMEL, Indiana 460329998 1740350814-0098 04/28/2014 (800)275-8777 10:58:36 AM -------------------------------------- Sales Receipt Product Sale Unit Final Description Qty Price Price INDIANAPOLIS IN 46254-2515 $0.70 Zone-1 First-Class Mail Letter 1 .40 oz. Expected Delivery: Tue 04/29/14 Return Rcpt (Green $2.70 Card) @@ Certified $3.30 USPS Certified Mail #: 70103090000202773221 Issue PVI: $6.70 Total: $6.70 Paid by: Cash $7.00 Change Due: -$0.30 @4 For tracking or inquiries go to USPS,com or call 1-800-222-1811 , BRIGHTEN SOMEONE'S MAILBOX. Greeting cards available for purchase at select Post Offices. C peett, NUMBER DATE DESbRlko"N OF • f ..........-.-.._...................-......-...-.............................................................................._.........................-.....-..-...............f...............-_....-.................. ......-.._...-...... CHARGE TO l�CCOUN C .......:.: A-9672/T-300Q RECEIVED B! "''�� APPROVE BYl � ^ Of rice.... X Of f'i ce.ax.#907,.' - =147W GREYHOUND'PLAZA-—" CARMEL, IN 46032 (317) 818-2690 0907 01 0650 06/19/14 12:28:09 PM SALE 037000348641 . L $1 .49 Puffs Plus.w/Loti:on Cube -5- 03 7 ube -5 -037000348641, _'�° i�_, $1'=49 Puffs Plus w/Lotion Cube 5 037000348641 $1 .49 Puffs Plus w/Lotion Cube 5 037000348641 $1 .49 Puffs Plus w/Lotion Cube 5 043100062066 $6.49 5Star 1SubNtbk CR 11x8.5 1 043100062066 $6.49 5Star 1SubNtbk CR 11x8.5 1 SubTotal $18.94 TOTAL "�Ali i�11'li J$18?94 VISA $18.94 Card number: XXXXXXXXXXXX5328 Authorization 002912 Tax Exempt ID: 000100328305 75700-00001-64100-00010-50191-90007 Pc NUMBER DATE 04 . f DESCRIPTION • AMOUNTR l CFARG�Tb/� COU[JT TONAL ' A-9672/T-3008 RECEIVED BY _ APPROVED BY l - 1 WELCOME TO CIRCLE K CIRCLE K 2368 57 444 808208 5453 RANGELINE RD S'ID0522 __CARMEL IN 46032 Descr. qty amount <CUSTOMER COPY> SM ICE BAG 7 LB 1 1.99 Sub Total 1.99 Tax 0.00 TOTAL 1 . 99 CREDIT $ 1 .99 XXXX XXXX XXXX 5328 VISA INVOICE: 804997 AUTH #: 0553512 THANKS COME AGA I N REG# 0003 CSH# 014 DR# 01 TRAN# 34539 04/21/14 12:55:46 ST# 2368 WELCOME TO CIRCLE K CIRCLE K 2368 57 444 808208 545 RANGELINE RD S1D0522 CARMEL IN 46032 Descr. qty amount NUSTOMER COPA SM ICE BAG 7 LB 1 1.99 Sub Total 1 .99 Tax 0.00 TOTAL 1 _ 99 CREDIT $ 1.99 XXXX XXXX XXXX 5328 VISA INVOICE: 805010 AUTH #: 095812 THANKS COME d4GA I N REG# 0003 CSH# 014 OR# 01 TRAN# 34542 04/21/14 12:58:31 ST# 2368 � q � DESCRIPTION OF ITEM/SERVICE PURCHASED AMOUNT i r of / 26 0880 Capitol Commons Self Park 10S.Cap ftol 317-951-0866 InterPark Receipt SEE REVERSE SIDE 81550245 This Cogtract Limits,Our Liability. Please Read It. Vehicles parked at this location are parked at the risk of the vehicle owner. The garage operator is not responsible or liable for loss or damages by reason of fire, theft, collision or other cause to parked vehicles or contents of same. This is a license, no bailment created. The vehicle owner and occupants assume full responsibility for any per- sonal injuries that may occur while the vehicle is parked in the parking facility. Employees are not authorized to change the items contained herein FOR CUSTOMER SERVICE CALL: (773)436-7275 1 II Bureau of Motor Vehicles kik Customer Transaction Receipt II IIIIIIIIIIIIIIIIIIIII IIIIII IIIIIIIIIIIIIIIII BIV State Form 51717 (4-04) Branch: CARMEL STARS(527) Date: 8/19/14 Time: 2:31:59 pm EDT 12955 OLD MERIDIAN ST STE 107 CARMEL, IN 46032-7106 Visit ID: 19532544 _ Visit Customer: JEFFREY W TRAGESSER Transactions Trans ID(PIN) Trans Tvae Trans Subtvpe Amount 238813973 Driver- Upgrade/Downgrade CDL Permit Upgrade/Downgrade $10.00 Subtotal: $10.00 Sales/Use Tax: $0.00 Credit Applied: Total: $10.00 - Payment Method CASH Amount $ 20.00 Total Due: $10.00 Amount Paid: $20.00 Change Due: $10.00 If you have questions or comments, please call our Customer Service Center at.888-myBMV-411. Please help us improve our service by completing a one-minute customer satisfaction survey. Your responses are completely confidential. Visit http://www.in.gov/bmvsurvey/start and enter the survey code 195325444 to get started. Thank you. www.Facebook.com/inbmv www.Twitter-.com/inbmv- www.myBMV.com= - -- - IIIIIIIIIIIIIIIIIVIII III II IIIII IIIII IIIII IIIII IIIII VIII VIII IIIII III Customer Copy 5 1 7 1 7 2 3 8 8 1 3 9 7 3 Page 1 of 1 I lc if ire.y c - -7 3 b a,o April 10, 2014 WASTEWATER CERTIFICATION EXAMINATION INSTRUCTIONS: 1. Cell phone use during the exam is not permitted. If you have brought a cell phone to the exam it must be switched off and secured out of sight for the duration of the exam. Likewise, all pagers or watch alarms must be turned off now. If a phone is used or if a pager or alarm sounds during the exam the monitors have the right to confiscate it until you have completed and turned in your exam. IDEM,the exam monitors,and the exam site/personnel are not responsible for lost or stolen property. 2. This is a closed book examination. Calculators and slide rules not capable of storing text are permitted. Use of reference materials, either in the exam room or outside the exam area during the exam is NOT allowed. Evidence of use of reference materials during the exam will result in a failing grade and the possible rejection of future applications. 3. Choose the BEST answer.Please make sure you read each question and all possible answers completely. If the question involves a numerical answer,be as exact as possible. 4. Mark only one answer for each question. If you wish to change an answer,erase the first answer completely. If more than one answer is marked, it will be counted wrong. If you are having difficulty with a complete erasure,point it out to the monitor upon completion of your exam. 5. Do your own work.Unapproved assistance will result in an automatic failure. 6. Do not mark or write in the test booklet or on test materials.Please use the blank paper provided.If you _ need additional blank paper, ask an exam monitor. All materials, except this sheet,must be turned in at the end of the examination. Failure to return the test booklet and/or the blank paper will result in a failing grade. You may take this paper with you provided you do not use it as scratch paper during the exam. 7. A score of 70% correct is required to pass this test. There are 100 questions in Classes I,11,III,IV,A,B, C, and D. There are only 50 questions in Classes I-SP and A-SO. 8. There is a time limit of 3 hours to complete the examination. 9. You will be notified of your test score by mail within 60 days of the test date. Pass/Fail results will be available via the Web at:http://www.in.gov/idem/5088.htm on or after Friday,May 9,2014. Your Test ID Number will be required to view your results,so please record it here: 10763 Alternatively,you may contact the certification office by phone on or after Friday,May 9,2014. The Office of Water Quality main line Is - - taff-at'i'L9=232=871 ur317-233-0479. Pease1 indicate that you are calling for pass/fail results for the Wastewater Certification Exam. 10. Marking the Answer Sheet. Mark your answers on the answer sheet by completely blackening the letter as shown in the samples below. The exam monitors will examine your answer sheet and if improperly marked you will be asked to correct it. Answer sheets will be electronically graded. WRONG WRONG WRONG WRONG CORRECT VOUCHER # 146237 WARRANT # ALLOWED 241763 IN SUM OF $ PETTY CASH - ADMIN C/O LISA 7 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO # INV# ACCT# AMOUNT Audit Trail Code 121514 01-7040-02 $10.00 121514 01-7042-06 $29.00 121514 01-7202-05 $3.98 121514 01-7200-08 $36.92 121514 01-7360-08 $6.70 Voucher Total $86.60 Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 241763 PETTY CASH -ADMIN Purchase Order No. C/O LISA Terms Due Date 12/9/2014 Invoice Invoice Description Date Number (or note attached-invoice(s) or bill(s)) Amount 12/9/2014 121514 $86.60 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 Date �*cer