HomeMy WebLinkAbout310302 04/18/17 CITY OF CARMEL, INDIANA VENDOR: 370676
ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITVHECK AMOUNT: $" ""'""120.00'
CARMEL, INDIANA 46032 PERMIT DIVISION CHECK NUMBER: 310302
302 WEST WASHINGTON ST,ROOM 241 CHECK DATE: 04/18/17
Mi oN.�o. INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4238900 767503302017 120.00 OTHER MAINT SUPPLIES
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ELEVATOR OPERATING CERTIFICATE INVOICE
ITY OF CARMEL ONE CIVIC SQUARE CARMEL IN 46032
1.If Code = * An annual test report is due before a permit is issued.
2.If 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
45583 * $120.00 $ 0.00 ONE CIVIC SQUARE, CARMEL IN 46032
Building Maintenance
Account # 3 �,9
Department # /Z O S'
Reference Number Invoice Date Please submit ENTIRE document with payment
7675-03302017 -1 03/30/2017 Unit(s) 1 Total Due upon receipt
of 1 $ 120.00 of $ 120.00
Owner Id 7675
Ref.Num. :7675-03302017 - 1 $120 of $ 120.00 Invoice Date 03/30/2017
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhaFeesFines/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 B-mail:elevator-invoice®dhs.in.gov 2.25% convenience fee
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Visa/Am.Express/Discover/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. :7675-03302017 - 1 $120 of $ 120.00 Invoice Date 03/30/2017