311472 5/23/2017 �'`���"'"•• CITY OF CARMEL, INDIANA VENDOR: 00352774
��; CHECK AMOUNT: $`"""""""34.17"
q ONE CIVIC SQUARE JORDAN KLEINSMITH
?a CARMEL, INDIANA 46032 C/o WASTEWATER CHECK NUMBER: 311472
� C/0 WASTEWATER CHECK DATE: 05/23/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 34.17 OTHER EXPENSES
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Welcome to Indiana Licensing Page 1 of I
/ndiana
Online Licensing .
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This page serves as your receipt for this transaction. Your payment will appear on your credit
card statement as "State of Indiana License Fee" or something similar. To maintain this page
for your records, you may print this page by clicking the "Print Receipt" button below.
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contact program staff at tfullerw@idem.in.gov
Payment received - thank you.
Licensee: I
License Number: WWO15515
Authorization Code: 01089R
Received Date: 5/10/2017 1:27:32 PM
Transaction ID: 74388442
Credit Card Number: XXXX XXXX
XXXX 2096
Fee Amount: $30.00
Enhanced Fee: $2.50
Instant Fee: $1.67
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