HomeMy WebLinkAbout319728 12/15/17 CITY OF CARMEL, INDIANA VENDOR: 229400
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI-MHECK AMOUNT: $*****"*240.00*
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFIC CHECK NUMBER: 319728
v� 302 W WASHINGTON ST,RM E221 CHECK DATE: 12/15/17
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4239099 240.00 OTHER MISCELLANOUS
Voucher No. Warrant No.
Indiana Department
229400 f_Homeland Security Allowed 20
sE aLDepartment
302 W 1'Nashmgton St., Rm E2 1
Ind'iana,'olis, IN 46204 In Sum of$
$ 240.00
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1093 734241112920171 4239099 $ 240.00 1 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
December 14, 2017
PAA�9��
Signature
$ 240.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032
l.If Code = * An annual test report is due before a permit is issued.
2.If Code = # A 5 year Test report is due before a permit is issued.
3.Over due fees must be paid before a permit is issued.
If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE,
AFFIRMATION" form.
State No.Code Due Over Due Location Address .
111704 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
111978 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032
DEC 0621017
Reffsre
+ F` ease submit ENTIRE document with payment
nce�biumb� � c'e$Ma;qt
7 3°4rZ�l 1 1F1G2 9�2 017=1 01.13�p:Tj 7ig, Unit(s) 2 T _
of 2 240.00 0 $ 240.00
Owner Id 734241
Ref.Num. :734241-11292017 - 1 $240 of '$ 240.00 Invoice Date 11/29/2017
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If Paying by check, include a check made payable to he Departxnent_of Homeland,eecurity .Yom can pay all your
payments online at ZDHS web site httpe://oas.dhe.in.govJdfbeJidhaFe'e'eFineey'start.do'with Visa/Master
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when
pa ing the dues online .OR-complete the,,following_information and return by maims I afana Department o
omeTand Security,„ F T;D�e�aztmet '3bZa WrW�as-hi-ng�ton�-St Rm E221,Indanagoli - IN�46204or^fa
3T')'2-33�=04�01.`Questions? call(317)232-6427 or E-mail:Zevato invoke@dhs.in.gov 2.25 convenience fee
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one)
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
Ref.Num. :734241-11292017 -1 $240 of $ 240.00 Invoice Date 11/29/2017