318187 11/07/2017 Coq.
CITY OF CARMEL, INDIANA VENDOR: 363665
� ® RICK T GALLE CHECK AMOUNT: S**......78.00*
ONE CIVIC SQUARE RIC sT GA LE CHECK NUMBER: 318187
�e? CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK DATE: 11/07/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
OTHER EXPENSES
101 5023990 FENCE REFUND 78.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or DEPT.# INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
the materials or services itemized thereon
for which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
r
oCA,?4" "COMPLETE&RETURN
�t:a,�,,,` REFUND REQUEST THIS FORM TO:
Building&Code Services City of Carmel
Ph. (317) 571-2444 Fax(317) 571-2499 Building&t Code Services
One Civic Square;
Carmel, IN 46032
PERMIT #(s): l '70 ? 0 6'7 L/
Lot & Subdivision, or Address of Construction:
3 -101 cern r- i
(If more than one address needs to be listed and will not fit,please attacWa printed list of all permits,with
their corresponding permit#.)
Please print or type the reason for the requested refund, and specific fee or fees
which are requested, in the lines below:
TOTAL REFUND AMOUNT REQUESTED: l
Applicant Signature Date
Applicant Name—Printed Company Name(If applicable)
APPLICANT ADDRESS:
-7o l Sckrn4e r CJS
Street Address
Car Mej f tU ° 0003 a
city ST zip
Phone# Fax#
FOR OFFICE USE ONLY:
p Total amount for fees that ARE available for refund:
p Fees that are NOT available for refund:
p Refund approved by: ' M I n Date: f
Lb
p Date submitted for Payment: Amount Approved:
CITY OF CARMEL
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: jkass
COPY # 1
Sec: Twp: Rng: Sub:A22 Blk: Lot:36
PARCEL ID . . . . . . . . : 1713060009024000
DATE ISSUED. . . . . . . : 08/14/2017
RECEIPT #. . . . . . . . . : EC000014189
REFERENCE ID # . . . : 17080094
SITE ADDRESS . . . . . : 3701 SUMTER WAY
SUBDIVISION . . . . . . : WESTON RIDGE
CITY CARMEL
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GALLE, RICK & TINA
ADDRESS 3701 SUMTER WAY
CITY/STATE/ZIP . . . : CARMEL, IN 46032
RECEIVED FROM . . . . : RICHARD GALLE
CONTRACTOR . . . . . . . : BULLSEYE FENCE DESIGN INC. LIC # FBULLFEN
COMPANY . . . . . . . . . . : BULLSEYE FENCE DESIGN INC.
ADDRESS . . . . . . . . . . : PO BOX 941
CITY/STATE/ZIP . . . : NOBLESVILLE, IN 46061-0941
TELEPHONE . . . . . . . . : (317) 774-0197
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
FENCE FLAT RATE 1 .00 50.00 0.00 50 .00 0 . 00
FENCEW 1 .00 28. 00 0 .00 28 . 00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 78.00 0.00 78 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 78. 00 visa
---------------
TOTAL RECEIPT 78 . 00
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24 Hour Customer Service#: 888-604-7888
PERMITS Payment Confirmation
PLC: CARMEL CITY DEPT OF COMMUNITY DATE: 08/14/17
9199 SERVICE
ONE CIVIC SQUARE
CARMEL, IN 46032
FOR: PERMITS
TRANSACTION INFORMATION
Name: RICHARD GALLE TRANSACTION
Permit/Docket REFERENCE#: 21015897
17080094
#: TRANSACTION 08/14/201711:21:19
Payment Type: PERMITS DATE/TIME: EDT
CARDHOLDER INFORMATION
NAME: RICHARD GALLE PAYMENT INFORMATION
ADDRESS: 3701 SUMTER WAY APPROVAL M 966601
CITY,STATE ZIP: CARMEL,IN 46032 PAYMENT AMOUNT: $78.00
PHONE#: 317-771-7152 SERVICE FEE: $3.75
CARD M xxxx-xxxx-xxxx-1542 TOTAL AMOUNT: $81.75
The service fee is not refundable.
ATTENTION CARDHOLDER:
If you have questions about the processing of your payment,please call GovPayNet at 888-604-7888.
Cardholder Signature: Date:
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®2007 Government Payment Service,Inc. Form#:EUR
https://www.govpaynow.com/gps/receipt?id=21015897&token=l 8/14/2017