HomeMy WebLinkAbout305189 11/14/16 CITY OF CARMEL, INDIANA VENDOR: 371293
® ONE CIVIC SQUARE INDIANA STATE CHEMIST CHECK AMOUNT: $****"***45.00*
:. CARMEL, INDIANA 46032 INDIANA STATE CHEMIST PURSUE UNIV. CHECK NUMBER: 305189
176 S.UNIVERSITY ST. CHECK DATE: 11/14/16
WEST LAFEYETTE IN 47907-2063
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 N35567 45.00 ORGANIZATION & MEMBER
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
INDIANA STATE CHEMIST ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
INDIANA STATE CHEMIST PURDUE UNIV. IN SUM OF$ CITY OF CARMEL
175 S. UNIVERSITY ST. An invoice or bill t0 be properly itemized must show:kind of service,where performed,dates service
WEST LAFEYETTE, IN 47907-2063 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$45.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Brookshire Golf Course Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
N35567 43-553.00 $45.00 1 hereby certify that the attached invoice(s),or 11/2/16 N35567 B Higgins Dues 2016 $45.00
1207 101 1207 101
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
Wednesday, November 02,2016
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Page 1
2017 INDIANA PESTICIDE COMMERCIAL APPLICATOR RENEWAL APPLICATION
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
CARMEL IN 46033-1212 Current Phone: (317)846-7431 Ext.
Current Fax:
Business e-mail: bhlggins@carmel.in.gov
Submit the Renewal Application in the enclosed envelope before December 31,2016.Those
applications postmarked after December 31,by law,require an additional 100%late fee penalty.
NOTE: Certification in each category is valid for a five(5)year period.
A license and technician registration is renewed each year prior to Decemb
License Number= N35567 FEE=$45.00 RENE DO NOT RENEW
ROBERT DAVID HIGGINS Personal e-mail: bhiggins@ca el.in.
Category 3A 3 CCHs earned out of 15 required Category Expires 1213112020
Category 3B 44 CCHs earned out of 20 required Category Expires 12/31/2017
Total Fee Due:$45.00
Submit the Renewal Application,in the enclosed envelope before December 31,2016.Those
applications postmarked after December 31,by law,require an additional 100%late fee penalty.
Send to: Office of Indiana State Chemist,Purdue University,175 S.University St.,West Lafayette,IN 47907-2063
Make check payable: Indiana State Chemist
I hereby swear and affirm that the list being submitted is a true and accurate record of the current certified employees working
at this business location.I also acknowledge that failure to provide accurate information on this application
form constitutes a violation of the Indiana Pesticide Use and Application Law(IC 15.3-3.6 Section 65(11)).
Printed Name ✓ Job title of person signi g
Signature Date
**** FOR STATE CHEMIST OFFICE USE ONLY****
APPROVED DATE
Check No Amount Entered Under
License# GN30022 Posted Account#
RT PAL
FAL Amount
Total Fee Due: $45.00