HomeMy WebLinkAbout309483 03/27/17 r Cqq
`F. CITY OF CARMEL, INDIANA VENDOR: 362497
ONE CIVIC SQUARE DEPT HOMELAND SECURITY �"
CHECK AMOUNT: $' 120.00'
rQ; CARMEL, INDIANA 46032 302 W WASHINGTON CHECK NUMBER: 309483
RM E221
�M«oaNDIANAPOLIS IN 46204 CHECK DATE: 03/27/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 767503022017 120.00 BUILDING REPAIRS & MA
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ELEVATOR OPERATING CERTIFICATE i.14vvit-E1 l
rmv DF CARMEL ONE CIVIC SQUARE CARMEL IN 46032
nermi
1.If Code = * An annual test report is due Pforeeforeaapermittississued-
2.If Code = # A 5 year Test report is due h
3.0ver 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
45561 $120.00 $ 0.00 3 CIVIC SQ, CARMEL IN 46032
Invoice Date Please submit ENTIRE document with payment
Reference Number 03/02/e D unit(s) 1 Total Due upon receipt
7675-03022017 -1 $ 120.00 of $ 120.00
of 1
Owner Id 7675 Invoice Date 03/02/2017
- 1 $120 of $ 120.00
If Paying by check, include a check made payable to the Department of Homeland security. You can pay a all your
Y
m oracle.in.gov/dfbs/idh"FeesFines/start.do with visa/Master
tion when
payments online at IDHS web site https:// Y
mail :Indiana Department of
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pullup
paying the dues online.OR complete the following information and return by
Homeland Security Fiscal call(317)23236427 or02 gE-mailnelevator-invoice®dhsainpgov82.25%4convenience fee
(317)233-0401. Questions?
a
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
State Zip Code
City
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Exp.Date (mm/YY)
Acct. Number
Signature
CVV2 Number Contact Phone Number the Cardmember's
By signing, cardmember agrees to the obligations set forth by
Agreement with the issuer.
Invoice Date 03/02/2017
Ref.Num. :7675-03022017 - 1 $120 of $
120.00