311512 5/23/2017 o".
CITY OF CARMEL, INDIANA VENDOR: 229400 *******ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIIRHECK AMOUNT: S 150.00*
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 311512
302 W WASHINGTON ST,RM E221 CHECK DATE: 05/23/17
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4239099 304619 25.00 OTHER MISCELLANOUS
1093 4239099 304624 25.00 OTHER MISCELLANOUS
1093 4239099 304625 25.00 OTHER MISCELLANOUS
1093 4239099 304626 25.00 OTHER MISCELLANOUS
1093 4239099 304627 25.00 OTHER MISCELLANOUS
1093 4239099 304628 25.00 OTHER MISCELLANOUS
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INVOICE FOR INSPECTION / CERTIFICATE FEES
State Form 356(R4/9-93)
Approved by the State Board of Accounts-1991
Division of Fire and Building Safety
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:/Imyoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 uo information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATE
NUMBEP. LATEST PLEASE
CARMEL CLAY PARKS & RECREATION I,
INVOICE PAY THIS
304619 1411 E 116TH ST DATE AMOUNT!
Owner Id ATTN DAWN KOEPPER
CARMEL, IN 46032-3455 05/03/2017
759531 j
Owner number User Name&Location of vessel Fee
MONON COIMMUNITY CTR
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
W T Blr - Hot Water cleating BRYAN 04/05/2017
i
National Board No. Inspection agency Name of inspector (This fee is
53252 HSBZ&I CO DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13) j
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304619,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
r r
4
INVOICE FOR INSPECTION / CERTIFICATE FEES 2017
State Form 356(R4/9-93) ,
w Approved by the State Board of Accounts-1991
v Division of Fire and Building Safely BY; r
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your pa entso;N,;w DHS welSsife
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https:l/myoracle.in.gov/dfbs/ldhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATE
NUMBER LATEST PLEASE
CARMEL CLAY PARKS & RECREATION
304620 INVOICE PAY THIS
1411 E 116TH ST DATE AMOUNT!
Owner!d ATTN DAWN KOEPPER
759531 CARMEL, IN 46032-3455 05/03/2017 V
-- ----- --- ..-. Fee J
Owner number User Name&Location of vessel MONON COMMUNITY CTR
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032 p
Serial number Description of vessel
Manufacturer Date Last Inspected
W T Blr - Hot Water Heating IBRYAN 04/05/2017
National Board No. Inspection agency Name of inspector (This fee is
53259 IHSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13)
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304620,05/03/2017 $ 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
2017
INVOICE FOR INSPECTION / CERTIFICATE FEES
Approved by Division of Fireeoard of Accounts- 991
and Building ng Safety
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online online at IDHS web site
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATE _
NUMBER LATEST PLEASE
CARMEL CLAY PARKS & RECREATION
INVOICE PAY THIS
304623 1411 E 116TH ST DATE AMOUNT!
Owner Id ATTN DAWN KOEPPER
759531 - CARMEL, IN 46032-3455 05/03/2017
Owner number User Name&Location of vessel Fee
MONON COMMUNITY CTR
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
' W T Boiler LOCHINVAR 104/65/2017
National Board No. Inspection agency Name of inspector (This fee is
184067 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13) —
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304623,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
r
7"
2017
INVOICE FOR INSPECTION / CERTIFICATE FEES
State Form 356(R4/9-93)
Approved by the State Board of Accounts-1991
Division of Fire and Building Safety s
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATF.
NUMBER LATEST PLEASE
CARMEL CLAY PARKS & RECREATION
INVOICE PAY THIS
304624 1411 E 116TH ST i DATE AMOUNT!
Owner Id ATTN DAWN KOEPPER —- ---
05/03/2017 7
759531 CARMEL, IN 46032-3455
Owner number User Name&Location of vessel MONON COMMUNITY CTR Fee
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
—Sepal number - --- -- - -- - - — —
Description of vessel Manufacturer Date Last Inspected
W T Boiler I LOCHINVAR 04/05/2017
National Board No. Inspection agency T Name of inspector (This fee is
195396 HSBI&I CO j DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13)
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304624,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
T^^-.��^ •��•.. ....nnninn fpr rnir rornMc
INVOICE FOR INSPECTION / CERTIFICATE FEES f
�, State Form 356(R4/9-93) �ti�l�Y j 2017
` Approved by the State Board of Accounts-1991 1
.; Division of Fire and Building Safety
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payme eat IDHS web site
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY haps://myoracle.in.gov/d 01wesistartA&. ••••••..• g
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATE
NUMBER LATEST PLEASE
CARMEL CLAY PARKS & RECREATION
304625 INVOICE PAY THIS j
1411 E 116TH ST DATE (AMOUNT!
Owner Id ATTN DAWN KOEPPER
759531 CARMEL, IN 46032-3455 05/03/2017
Owner number I User Name&Location of vessel Fee
THE MONON CTR
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032 --
Serial number Description of vessel Manufacturer Date Last Inspected
: W T Boiler , LOCHINVAR 04/05/2017
IN Board No. Inspection agency Name of inspector (This fee is
181548 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13)
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA REINSPECTION--304625,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
--k—�- A-- .n i—for vour records
INVOICE FOR INSPECTION CERTIFICATE FEES ti
Olt
State Form 356(R4/9-93) J4��A� 1
Approved by the State Board of Accounts-1991
1.Mail checks payable of Fire and Building Safety
p y e to DEPARTMENT OF HOMELAND SECURITY You can pay all your p rSgpljgg ,lp�{�,�g�,�ite-,,,,,, y
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY haps://myoracle.in.gdv/df6�7idn�rreEsffnESf!tart'dtr---
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone (317)232-1921
INDIANA STATE
NUMBER
CARMEL CLAY PARKS & RECREATION LATEST PLEASE
304626 i INVOICE PAY THIS
1411 E 116TH ST 1 DATE AMOUNT!
Owner Id ATTN DAWN KOEPPER
759531
CARMEL, IN 46032-3455 05/03/2017
Owner number User Name&Location of vessel THE MONON CTR Fee l
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
W T Boiler ! LOCHINVAR 04/05/2017
National Board No. Inspection agency Name of inspector (This fee is I
181626 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
675 IAC 12-3-13) --I
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304626,05/03/2017 $ 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
T-.^•1 —•.. f—nn.finn fnr vour records
INVOICE FOR INSPECTION CERTIFICATE FEES FBY
�/� r 201 1/
State Form 356(R4/9-93)
Approved by the State Board of Accounts-1991 Division of Fire and Building Safety ,
...
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments onlmeat'It"web site,
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
INDIANA STATE - --_--- T
NUMBER CARMEL CLAY PARKS & RECREATION LATESTPLEASE
INVOICE PAY THIS
304627 1411 E 116TH ST
DATE (AMOUNT.
Owner Id ATTN DAWN KOEPPER
759531 CARMEL, IN 46032-3455 05/03/2017
Owner number User Name&Location of vessel _TFee
THE MONON CTR
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
W T Boiler LOCHINVAR 04/05/2017
National Board No. Inspection agency Name of inspector (This fee is
181533 HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
1- 675 IAC 12-3-13)
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304627,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
T. he 4ti,t—n—tinn for vour records
c 771
f
a INVOICE FOR INSPECTION / CERTIFICATE FEES
State Form 356(R4/9-93)
`. Approved by the State Board of Accounts-1991
Division of Fire and Building Safety A. "........... .....
1.Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your paym ne is on to
2. Mail 2nd copy&check to DEPARTMENT OF HOMELAND SECURITY https://myoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
302 W WASHINGTON ST.,RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204-2739 up information when paying the dues online.
Telephone:(317)232-1921
------ _--- ----- - — - -- � -- -
INllIA211A STATE
NUMBER
CARMEL CLAY PARKS & RECREATION^ LATEST N j PLEASE
PAY
INVOICE THIS
304628 1411 E 116TH ST DATE AMOUNT!
Owner Id ATTN DAWN KOEPPER
759531 CARMEL, IN 46032-3455 05/03/2017
Owner number User Name&Location of vessel THE MONON CTR Fee
1235 CENTRAL PARK DR E $ 25.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer
Date Last Inspected
' W T Boiler ' LOCHINVAR 04/05/2017
National Board No. 11 Inspection agency Name of inspector (This fee is
181629 i HSBI&I CO DRAPER-MATTHEW JASMINE prescribed by
—1 ---_.--- 675 IAC 12-3-13) --�
Inspection Date Inspector Name Inspection Type Due
04/05/2017 DRAPER-MATTHEW JA RE-INSPECTION--304628,05/03/2017 S 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT