250413 10/07/15 CITY OF CARMEL, INDIANA VENDOR: 368793
ONE CIVIC SQUARE MICHAEL SHEEKS CHECK AMOUNT: $**......30.00*
CARMEL, INDIANA 46032 14382 WHISPER WIND DR CHECK NUMBER: 250413
CARMEL IN 46032 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4357004 REIMB 30.00 EXTERNAL INSTRUCT FEE
IICC
APPLICATION Cert. No.
for
CERTIFICATES REQUIRING
, . MULTIPLE EXAMINATIONS
t This application is not required for
Fire Inspector I/or Certified Fire Marshal.
To receive a certification that requires the completion of more than one examination, complete this application and
submit.to ICC at the address at the bottom of this page with appropriate fee payment. Enclose $30.00 for each certi-
fication.category. Master Code Professional and Certified Building Official certifications are complimentary.
Please do not submit this application prior to receiving your certificate and/or wallet card for the clualifying
examinations.
I have successfully completed the required examinations and request certification for:
❑ B5 Building Inspector �R5-Residential:Combination Inspector ❑ F6 Certified Fire Code Official
❑ E5 Electrical Inspector ❑ C5 Commercial Combination Inspector ❑ M6 Certified Mech Code Official
❑ M5 Mechanical Inspector ❑C8 Combination Inspector ❑ P6 Certified Plbg Code Official
❑P5 Plumbing Inspector ❑ C3 Combination Plans Examiner ❑ H6 Cert Housing Code Official
❑ B6 Certified Building Code Official ❑CB Certified Building Official*" ❑ E6 Cert Electrical Code Official
❑ MP Master Code Professional" ❑ MI Master of Special Inspection ❑ G8 Energy Code Specialist
❑T6 Permit Specialist
Certificate and Mailing Information }'$30 fee does not apply to MCP or CBO certification categories
94 I'Lk a-t? I � 8- l�-S
Name Please print your name as you desire it to appear on each certificate.
I X13 (�,Z ��t►sir er (z; V. fir; of
Mailing Address
Cs>_ r
City State ZIP
Contact Phone Number Email Ad-dress
-wl
Signature Date
Note: 45-70 days is required for verification of records prior to issuance of requested certificates.
Y
Payment Information �,,�
Total number of certification categories: �_ X $30 per category = k �O otal to enclose. SIL
Method of Payment
ACheck or money ordeayable to: ICC
❑Visa ❑ Master ❑ merican Express ❑ Discover
Credit Card No. / / / Expires /
Signature of Cardholder Date
Name as it Appears on Credit Card
Mail completed application with required fee payment to:
International Code Council
Certification &Testing Department
900 Montclair Road
Birmingham, AL 35213
OFFICE USE ONLY
Candidate ID: Requirements met: Date processed: Initials:
=859-749 .
CINDY OR-MIKE SHEEKS 6082
14382"WHISPER_WIND DRIVE
CARMEL, IN 46032
PA��
to the order of ;. -
FIFTH THIRD.BANK q.
BAR -
:
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))
10/05/15 $30.00
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
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Michael Sheeks
IN SUM OF $
C/O One Civic Square
Carmel, IN 46032
$30.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACcT#rriTH AMOUNT Board Members
1192 43-570.04 $30.00
I hereby certify that the attached invoice(s), or
I 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, October 05, 2015
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund