HomeMy WebLinkAbout253372 01/15/16 Gnq
J^% CITY OF CARMEL, INDIANA VENDOR: 229400
tl ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIWECK AMOUNT: $*******120.00*
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 253372
M�furi, 302 W WASHINGTON ST,RM E221 CHECK DATE: 01/15/16
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350900 12282015 120.00 734241122820151
Ii
1
Voucher No. Warrant No.
Indiana Department
229400 of Homeland Security ', Allowed 20
Fiscal Department f
302 W Washington St., Rm E221
Indianapolis, IN 46204 In Sum of$
$ 120.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1093 734241122820151 4350900 $ 120.00 1 hereby certify that the attached invoice(s), 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
I
January 6, 2016
Signature
$ 120.00 Accounts Payable Coordinator
Cost distribution ledger classification if I Title
claim paid motor vehicle highway fund
I
ELEVATOR OPERATING CERTIFICATE INVOICE
ARMELjCLAY BOARD OF PARKS a RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
1.1f Code = * An annual test report is due before a permit is issued.
2.1f Code = # A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a permit is- issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111703 $120.00 $ o.oc) 1235 CENTRAL PARK DR EAST, CARMEL IN 40632
7015
Reference Number invoice Date Please submit ENTIRE document with payment
734241-12282015 -1 12/28/2015 Unit(s) I Total Due upon receipt
of 1 120.00 of $ 120.00
Owner Id 734241
Ref.Num. :734241-12282015 -1 $120 of $ 120.00 Invoice Date '12/28/2013
If Paying by check, include a check made payable to the Department o£ Homeland security. You can pay all you
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesFines/start.do with Visa/Master
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
paying the dues online.OR complete the following information and return by mail :Indiana Department of
Homeland Security, Fiscal Department, 302 W.Washington St., Rm : E221,Indianapolis, IN 46204 or fax to
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice@dho.in.gov 2.25% convenience fee
charged on all credit card payments.
Full Name on Credit Card
BillingAddress: Street
City State Zip Code
CC type:Visa/Am.Express/I)iscover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
Ref.Num. :734241-12282015 -1 $120 of $ 120.00 Invoice Date 12f28/2015
X41 ELEVATOR OPERATING CERTIFICATE INVOICE
JCARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
1.If Code = * An annual test report is due before a permit is issued.
2.1f Code = # A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a permit is issued.
If elevator(s) 'are not in service please request an "ELEVATOR OUT OF SERVICE
AFFIRMATION" form.
State No.Code Due Over Due Location Address
111703 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632
DE