309864 4/4/2017 (9)
CITY OF CARMEL, INDIANA VENDOR: 00351564
ONE CIVIC SQUARE GARY CARTERCHECK AMOUNT: S"""`"15.00`
CARMEL, INDIANA 46032 4748 BISHOPSGATE DR CHECK NUMBER: 309864
CARMEL IN 46032 CHECK DATE: 04/04/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4358300 15.00 OTHER FEES & LICENSES
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Ui *v Bureau of Motor VehiclesCustomer Detailed Transaction Receipt
State Form 51714 (4-04)
Branch: VEHICLE SERVICES- REGISTRATIONS Date: 03/17/2017 Time: 7:47 EDT
Visit ID: (21768947 CSR: SL
Visit Customer: CITY OF CARMEL
Transactions
Trans ID Trans Tvae Trans Subtvpe Amount
275845576 Title- Initial Title Issuance New
Title-Vehicle $15.00
Vehicle: 1 FDUF4HT3HDA01424 2017 BRA UNK YY
Lien Holder: REGIONS CAPITAL ADVANTAGE
1900 5TH AVE N 2400
BIRMINGHAM, AL 35203-2610
Customer: CITY OF CARMEL
Purchase Date: 03/03/2017
$15.00
Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1
Bureau of Motor Vehicles
'`� �` Customer Registration Fees Detailed Receipt
BMV
� .; State Form 51718 (4-04)
Branch:VEHICLE SERVICES- REGISTRATIONS Date: 03/17/2017 Time: 7:29 EDT
Visit ID: A 7868947 Tran ID: 275845610
Visit Customer: CITY OF CARMEL STARS Trans# 03171780300006
Transaction Type: New Motor Vehicle Registration
Registration License Type: MUNICIPAL OWNED
PlatelPermitlRegistration Number:
Vehicle Identification Number: 1 FDUF4HT3HDA01424
Vehicle Year: 2017
Vehicle Make. BRAUN
Vehicle Model: UNKNOWN
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
Approved e
vedbyStaState Form 48099
lBoardof INDIANA CERTIFICATE OF VEHICLE REGISTRATION
00 " Accounts 2016
CLASS I AGE I ISSUE DATE I PUR DATE COUNTY TP I PLYR PLATE PL TP I WEIGHT I PR YR I LS I TYPE I PRIOR YR PL
03/17/2017 03/03/2017 29-HAMILTON N 16 MO N
EXPIRATION DATE MUNICIPALITY VEHICLE YEAR MAKE 1 MODEL I VEHICLE IDENTIFICATION NUMBER I TYPE I COLOR
NO EXP 2017 BRA UNK 1FDUF4HT3HDA01424 AM 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
1 CIVIC SQ SL
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
fT4T`"
APPLICATION FOR CERTIFICATE OF TITLE FOR A VEHICLE
t 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 Date(mm/dd/yyyy)
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 Invoice Number BMV Use Only
03171780300008 803 MV-GOVERNMENT-PREVIOUS TITLE
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 Identification Number Vehicle Year Vehicle Make Vehicle Model Vehicle Type Odometer ACTUAL
1 FDUF4HT3HDA01424 2017 BRA LINK AM 597 M
Former Title Number Purchase Date(mm/dd/yyyy) Lien(YIN) Speed(YM) Dealer Number BMV Use Only
OH 03/03/2017 1 No
Holder of First Lien,Mortgage,or Other Encumbrance/Special Mailing Address Mailing Address(number and street)
REGIONS CAPITAL ADVANTAGE 1900 5TH AVE N 2400
City State ZIP Code BMV Use Only
BIRMINGHAM AL 35203-2610
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
SL
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 VIII VIII VIII VIII VIIIVIIIIIII
IIII
2 0 5 2 7 5 8 4 5 5 7 6
CUSTOMER COPY