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315177 8/22/2017 (9, ) CITY OF CARMEL, INDIANA VENDOR: 358941 ONE CIVIC SQUAREPETTY CASH -BROOKSHIRE GOLF COU(ridICK AMOUNT: S********49.47CARMEL, INDIANA 46032 C/O PAM LISTER CHECK NUMBER: 315177 CHECK DATE: 08/22/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4355300 49.47 ORGANIZATION & MEMBER n _o -0 < « g m O q k � ( 2 © > > k n J 0 ( ® m n E ƒ w m ? \ ƒ 2 K G) < m # O % ? g k k E $ q J O ; m # 27 - _ O > � k X % w = / O » \ G § En 0 0 m ; P # E / \ (D z \ z z > 0 m 4(A3 q C § § | = 4 w 6 J a ! e L7 - z z % / I 2 r % A g / / $ 2 m - k §� e a ; / § k / a � 2 7 (D \ > _ - c m CL \ \ % 3 Q CL m f / � g I k k mCL \ / / Ek K § a § § , - ± K M G $ m § E § kƒ � \ 2 / \ } § . ) K k > / ) � r \ CD, / . m mz ; CD E Q a \/ k ) � m ƒ \ = C\ G) D � / ( ik k k § Ln00 > e° � � }/ CD gr §_\ ) Q « Co CD OL m § 0 \ n / j _E \ r 0 � # 2Z ) CD C 0 � m ® 0 % } ƒ_ § S / k , 0 \ ) M / § 0 \ \ ƒ ] § k OL > � / _ 0 . \ m Z ° \ Welcome to Indiana Licensing Page 1 of 1 Indiana r Online Licensing Payment Receipt This page serves as your receipt for this transaction. Your payment will appear on your credit card statement as "STATE OF IN WWW INGOV 800-236-5446 IN". New Application • Completion of Server Training is required within 120 days of issuance of this permit. Click here to complete Server Training online • A BMV Operating While Intoxicated (OWI) Check is preformed on every application prior to issuing a permit. Please allow 24 - 48 hours to complete the check before your permit will be issued. • You may print this receipt and use it to work for 90 days, or until your new permit arrives in the mail. • This receipt must be printed now. You will not be albe to reproduce it at a later time. • All permit application and renewal fees are now non-refundable. Payment received - thank you. Licensee: Eric Groganz License Number: Pending Authorization Code: 085541 Received Date: 8/19/2017 12:30:53 PM Transaction ID: 78117128 Credit Card Number: XXXX XXXX XXXX 6072 Fee Amount: $45.00 Enhanced Fee: $2.50 Instant Fee: $1.97 Total Payment: $49.47 r °pri R ..gi MvLicense Home Logout https://mylicense.in.gov/EGov/PaymentResult.aspx?answer=processed&credit_card numb... 8/19/2017