312317 06/13/2017 CITY OF CARMEL, INDIANA VENDOR: 371727
ONE CIVIC SQUARE ASIAN ART SOCIETY OF IMA CHECK AMOUNT: S""'""""100.00"
CARMEL, INDIANA 46032 C/O NANCY INUI CHECK NUMBER: 312317
�M. 1338 N NEW JERSEY ST CHECK DATE: 06/13/17
INDIANAPOLIS IN 46202
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GAZEBO 100.00 OTHER EXPENSES
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Approvals/Date
Nancy Heck tel, ks�
CITY OF CARMEL Lt.Joe Bickel OK-.5Aa-1-7 7-A
Adam Harrington OK-3-a9-177 oA
FACILITY USE REQUEST FO,
,4ame/Organization: Ag1),Sejj rX Ak
Point of Contact: UIU
l
Address:
City,State,Zip: As62,2
Home Phone: 0-W q(7-9 7 (< Cell Phone: 617)
Email Address: V151 nuc ,a DU B C h, D Fax Number i )
For Profit Organization: Non-Profit Organization: �_Individual:
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Day and Date Requested: S U K AOto, J
Time Requested: y a.m .m to: a.m.
(This includes set-up and clean-up time.)
Rehearsal Date: Time: a.m./p.m. to a.m./p.m.
City Facility Requested: Gazebo— Fountain Area Japanese Garden
Palladium Center Green Caucus Room (1/3)—(2/3)_Council Chambers
Special Requests: Electricity Fountain Restroom Other
Purpose: tQ � t('_- Number of People Expected: -
Vendors: Yes_ No (See Item 5,City of Carmel Facility Use Policy attached)
City Street Closing: (See Item 9,City of Carmel Facility Use Policy attached)
I
Large or Race Events: IJ
Neighborhood Street Closing(Street(s),Address(es) Blocked)
The Carmel Board of Public Works and Safety reserves the right,in its sole discretion,to deny
any facility use request and/or revoke any previously granted request to use a City facility for
any lawful reason.
Received this Q 7 +k`day of {�'�Q,r .201 7
Mayor's Office
Revised: 01/01/2016
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