249283 09/09/15 1,u;Coq*f
CITY OF CARMEL, INDIANA VENDOR: 120950
6 ! ONE CIVIC SQUARE DOUGLAS HANEY CHECK AMOUNT: $'"""*'11 11.22-
CARMEL,a4 CARMEL, INDIANA 46032 C/O DEPT OF LAW CHECK NUMBER: 249283
�1,,,r�N�o; C/0 DEPT OF LAW CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4358300 11.22 OTHER FEES & LICENSES
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Your transaction is complete. Print this receipt for your records. Your receipt identification
number is 18159913. Please reference this number in any correspondence regarding your
transaction.
DOUGL4gHAmFv
CARMEL, lN40033
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Phone : 317 - S71 - 2472
|
Email : dhaney@carmel.in.gov
Ac�o�r� �p��r,n���n,� �
4*********** exp.
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Notary Application Fee $10.00 1 $10.00
Instant Access Fee ¢1.22 1 $1.32
11,22
The following amounts have been charged to your credit card. Your credit card statement will
show the following merchant name(s) and amount(s) for this transaction.
;4n8chant
IN Sec ofState 800-336-5446 $11.22
|
The total amount charged to your credit card is $11.22.
Privacy Statement
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ME
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THAT I'47 THE NAME AND BY THE :�S�I'I~f�0Ri'�'4�OF
THE STATE.OF INDIANA, I DO HEREBY APPOINT AND COMMISSION AS
A Notary Publi 0 c
COMMISSION NUMBER: 672449
DOUGLAS C HANEY
CARMEL, IN 46033
WITHIN AND FOR THE COUNTY OF HAMILTON
AND THE STATE OF INDIANA
FROM SEPTEMBER 2, 2015 UNTIL AND EXPIRING ON SEPTEMBER 1, 2023
e rrt1� hereof
STAB
I HAVE HEREUNTO SET MY HAND AND
'' `'• +' ° CAUSED TO BE AFFIXED THE SEAL OF
• �i1 '�. °°a� THE STATE, AT THE CITY OF
INDIANAPOLIS, ON SEPTEMBER 2, 2015
MIKE PENCE — GOVERNOR
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Job
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
Douglas Haney
Purchase Order No.
1 Civic Square
Terms
Carmel, Indiana 46032
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/3/15 reemb rsernent for fees associated with Notary $11.22
per the attached
Total
$11.22
1 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.
ALLOWED 20
Douglas Haney IN SUM OF $
1 Civic Square
Carmel, Indiana 46032
$ $11.22
ON ACCOUNT OF APPROPRIATION FOR
Department of Law
4358300 Other Fees & Licenses
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
1180 4358300 $11.22 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
r � 2015
ignature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund