HomeMy WebLinkAbout243513 03/24/15 '�'..c,A,,�. CITY OF CARMEL, INDIANA VENDOR: 00352767
1. CHECK AMOUNT: $***""*"225.00'
ONE CIVIC SQUARE WILLIAM HOHLT
x. ?Q, CARMEL, INDIANA 46032 C10 Docs CHECK NUMBER: 243513
9M�roN�°� CIO DOCS CHECK DATE: 03/24/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4355300 225.00 ORGANIZATION & MEMBER
Add- ICC Renewal Application Page 1 of 1
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Renew Certifications I Verify renewal application
Certification Program Current Expiration Date New Expiration Date
Residential Combination Inspector _ _ 1/5/2015 3117/2018
Property Maintenance&Housing Inspector 1/5/2015 3/17/2018
Total
Quantity Of CEUs Required: 3.00
Price: $225.00
0 I Hereby Certify,To The Best Of My KnovAedge And Belief That All The Information I Have Provided Is Accurate.
I FurtherAcknowtedge That Should The Information I Have Provided Be Inaccurate It May Result In Sanctions,Including But Not Limited
To The Revocation Of My Certificate,As Provided By The Rules Of The Program.
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Thank you for your order.
Your Confirmation Number Is VTJPCF4C983A.
You May Print This Page For Your Records.
Item quantity price discount tax shipping net-total
Renew 2-5 Certifications 1.00 100.00 $0.00 $0.00 $0.00 $100.00
Certification Reinstatement Fee 1.00 125.00 $0.00 $0.00 $0.00 $125.00
Billing/Shipping Information
Customer Name: Hohit William G Billing Name: Hohlt William G
email: whohit@carmel.in.gov Contact:
phone:(317)571-2470
Shipping Label: William G Hohlt Billing Label: William G Hohlt -
city of Carmel city of Carmel
13539 shelbome road 13539 shelborne road
Carmel,IN 46074 Carmel,IN 46074
Payment Information
Payment Amount 225.00 Net-Total: $225.00
Payment Method: Net-Applied: $225.00
Cardholder's Name: William G Hohit Net-Balance: $0.00
Credit Card Number. Net Credit: $0.00
Expiration Dale:
Authorization Code: 09989D
Reference Number. VTJPCF4C983A
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VOUCHER NO. WARRANT NO.
ALLOWED 20
William Hohlt
IN SUM OF$
i
c/o One Civic Square
Carmel, IN 46032
$225.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1192 43-553.00 $225.00
I hereby certify that the attached invoice(s), or
I I
! 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
Monday, March 23, 2015
0
I
Director
Title
I
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, 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))
03/17/15 Certs. $225.00
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