HomeMy WebLinkAbout247618 07/15/15 CITY OF CARMEL, INDIANA VENDOR: 229400
® hal ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURfJqHECK AMOUNT: $.....***25.00*
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 247618
302 W WASHINGTON ST,RM E221 CHECK DATE:. 07/15/15
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 317065 25.00 OTHER EXPENSES
1
°=:,Q INVOICE FOR INSPECTION / CERTIFICATE FEES _.
t; State Form 356(R4/9-93)
` Approved by the State Board of Accounts-1991 U
a
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS:
2. Mall 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY
402 W WASHINGTON ST.,RM 246
INDIANAPOLIS IN 46204-2739 Current Due
Fax.(317)234-8436
INDIANA STATE LATEST [AMOUNTI
LEASE
NUMBER CARMEL WASTE WATER PLANT INVOICE AY THIS
DATE
317065 9609 HAZEL DELL
INDIANAPOLIS, IN 46280 05/15/2015
Owner number User Name&Location of vessel CARMEL WASTE WATER PLANT Fee \/
9609 HAZEL DELL $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
R726105555 ALUMINUM BOILER HARSCO P&K 03/23/2015
National Board No. Inspection agency Name of inspector (This fee is
TRAVELERS REEVES JOSEPH prescribed by
IC 22-12-6-10)
2of3
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm No.201(Rev.199q
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))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited:same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALL WED 20
�lJl
.\ SUM OF$
yL
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
EPI# I hereby certify that the attached invoice(s),
SD72% 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
a
"2
= griyd ure
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund