308822 03/07/17 CITY OF CARMEL, INDIANA VENDOR: 00351564
ONE CIVIC SQUARE GARY CARTER CHECK AMOUNT: $ ... '15.00`
(9, ) CARMEL, INDIANA 46032 4748 BISHOPSGATE DR CCHECK HECK NUMBER: 03 822
CARMEL IN 46032
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4358300 15.00 OTHER FEES & LICENSES
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Bureau of Motor Vehicles
:=� �. Customer Transaction Receipt I IIIIIIIIII)(IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
B(�V
. , State Form 51717 (R/4-16)
Branch: VEHICLE SERVICES- REGISTRATIONS(803) Date: 2/23/17 Time: 1:31:55 pm EDT
100 N SENATE AVE
INDIANAPOLIS, IN 46204-2273
Visit ID: 217175146
Visit Customer: CITY OF CARMEL
Transactions
Trans ID (PIN) Trans Tyne Trans Subtype Amount
274696287 Title- Initial Title Issuance New $15.00
274698305 Registration - New Motor Vehicle Registration New $0.00
Subtotal: $15.00
Sales/Use Tax: $0.00
Credit Applied: $0.00
Total $15.00
Payment Method CREDIT Amount $ 15.00
Merchant ID 803BMV Card Type MASTERCARD Authorization Number 04617B
Terminal ID 2UA52319GZ Entry Method K — quence No 71314376
Batch No 0 Number """"""""""""7551
Total Due: $15.00 ! t , S
Amount Paid: $15.00 ?,
Change Due: $0.00 Q, t j D
If you do not receive your credential, n n 2 tions regarding the print/mailing status of
your credential, registration or title, plt Z o your account or call the BMV Contact
Center at 888-692-6841. You will be i �� t �`�` o'`f 5 �[ title by using your Transaction ID PIN
number listed above and calling 888-65 /, ved Personalized License Plate.
You may renew your motorcycle learne �i /' l not obtain a motorcycle endorsement
before the expiration of the renewed mo o apply for a new permit(IC 9-24-8-3).
Please help us improve our service by survey. Your responses are completely
confidential. Visit http://www.in.gov/bmvs purvey code 217175146 to get started. Thank you.
www.Facebook.com/inbmv U www.Twitter.com/inbmv www.myBMV.com
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5 1 7 1 7 1127 4 6 9 83111110111 0 5
Page 1 of 1
\ 1 * Bureau of Motor Vehicles
* * , Customer Registration Fees Detailed Receipt
. f * .
BMV* State Form 61718 (4-04)
r
Branch:VEHICLE SERVICES- REGISTRATIONS Date: 02/23/2017 Time: 13:12 EDT
Visit ID: 91475146 Tran ID: 274698305
Visit Customer: CITY OF CARMEL STARS Trans#. 02231780300015
Transaction Typec New Motor Vehicle Registration
Registration License Type: MUNICIPAL OWNED
PlatelPermitlRegistration Number:
Vehicle Identification Number: 75307401
Vehicle Year: 2017
Vehicle Make: HARRIER TRAILER
Vehicle Model: HA20N3C4E-GS25
Registration Year Fee Type Subtotal Total
2017
Total for 2017:
2016
NONE (NONE)2016 $0.00
CITY OF CARMEL
Total NONE(NONE)2016: $0.00
Total for 2016: 0.00
Transaction Totat 0.00
Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1
APPLICATION FOR CERTIFICATE OF TITLE FOR A VEHICLE
State Form 205(R9/7-16)
Approved by State Board of Accounts,2016
INDIANA BUREAU OF MOTOR VEHICLES
'This agency is requesting disclosure of your Social Security Number/Federal Identification Number in accordance with IC 4-1-8-1;disclosure is
mandatory,and this record cannot be processed without it
To be completed by a police officer,BMV official,or BMV certified I swear and affirm that I am authorized to perform this transaction,and
dealer signee for out-of-state titles. I hereby certify that I personally I agree to indemnify and hold harmless the Indiana BMV from any and
examined the following vehicle and find the identification number to all liability arising from this transaction.
be as follows.
I swear and affirm that the information that I have entered on this form
Vehicle Identification Number is correct.I understand that making a false statement on this form may
constitute the crime of perjury.
-- - - Applicant Signature:
Year Make Model Type j Date(mm/d 433)
Printed Name:
Inspector's Printed Name and Title City Applicant Signature:
Printed Name:
Inspector's Signature Badge,Branch,or Dealer Plate Number
Date(mm/dd/yyyy):
Transaction Number Branch Number 1 Invoice Number BMV Use Only
02231780300208 803 MV-GOVERNMENT-CERTIFICATE OF ORIGIN
- - -- --- - - - -- - - -
Social Security Number/Federal Identification Number" Name of Applicant BMV Use Only
CITY OF CARMEL
Residence Address(number and street) City State ZIP Code
1 CIVIC SQUARE CARMEL IN 46032
--- --Vehicle Yea- - - -- —-
Vehicle Identification Number r Vehicle Make Vehicle Model Vehicle Type Odometer EXEMPT
75307401 2017 HAR TR 0 M
Former Title Number Purchase Date(mm/dd/yyyy) Lien(YIN) Speed(YAW Dealer Number BMV Use Only
C OF O 01/12/2017 1 No
Holder of First Lien,Mortgage,or Other Encumbrance/Special Mailing Address Mailing Address(number and street)
REGIONS CAPITAL ADVANTAGE INC 1900 FIFTH AVENUE ST
City State ZIP Code BMV Use Only
BIRMINGHAM AL 35203
Holder of Second Lien,Mortgage,or Other Encumbrance Mailing Address(number and street)
City State ZIP Code License Number License Year Forms Use',, BMV Use Only
LA
Gross Retail and Use Tax Affidavit-IMe hereby certify that sales or use tax on this vehicle was paid as indicated below.
Selling Price Less Trade-In/Discount Amount Subject to Tax Amount of Tax ! Dealer Branch Exempt Exemption Code
$ 0.00 $ 0.00 0.00 $ 0.00 $ X 1
II VIII VIII III II VIII VIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
2 0 5 2 7 4 6 9 6 2 8 7
CUSTOMER COPY
State Form 48099(134/1-17)
Approved by State Board of INDIANA CERTIFICATE OF VEHICLE REGISTRATION
N,_ f' Accounts 2016
CLASS I AUJ ISSUE DATE PUR DATE COUNTY TP I PL YR PLATE PL TP I WEIGHT I PR YR LS TYPE PRIOR YR PL
02/23/2017 01/12/2017 29-HAMILTON N 16 MO N
EXPIRATION DATE MUNICIPALITY VEHICLE YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER TYPE COLOR
NO EXP 2017 HAR 75307401 TR RED/
CURRENT EX TAX EX CREDIT DAV CREDIT NET EX TAX CO.WHEEUSUR MUN.WHEEUSUR STATE REG FEE ADMIN FEE TOTAL
YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
PRIOR EX TAX EX CREDIT DAV CREDIT NET EX TAX CO.WHEEUSUR MUN.WHEEUSUR STATE REG FEE ADMIN FEE TOTAL
YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
REGISTRATION LICENSE TYPE
MUNICIPAL OWNED
CITY OF CARMEL N
2 CIVIC SQ LA
CARMEL, IN 46032-2584
IMPORTANT REGISTRATION INFORMATION
The registrant acknowledges that the information provided on the front of this
form is correct. The registrant understands that proof of financial
responsibility(insurance)for this vehicle will be continuously maintained
during the registration period. Additional taxes and/or fees may be due if an
error or an adjustment to the amount due is made.
CUSTOMER COPY