331528 10/25/18 CITY OF CARMEL, INDIANA VENDOR: 371293
ONE CIVIC SQUARE INDIANA STATE CHEMIST CHECK AMOUNT: $********90.00*
CARMEL, INDIANA 46032 INDIANA STATE CHEMIST PURDUE UNIV. CHECK NUMBER: 331 528
175 S.UNIVERSITY ST. CHECK DATE: 10/25/18
WEST LAFAYETTE IN 47907-2063
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 90.00 ORGANIZATION & MEMBER
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 371293 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
INDIANA STATE CHEMIST IN SUM OF$ CITY OF CARMEL
INDIANA STATE CHEMIST PURDUE UNIV. An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
175 S. UNIVERSITY ST. rendered,by whom,rates per day,number of hours,rate per hour,numberof units,price per unit,etc.
WEST LAFAYETTE, IN 47907-2063
Payee
$90.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Course Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
B Higgins/R 43-553.00 $90.00 1 hereby certify that the attached invoice(s),or 10/22/18 B Higgins/R Renewal Fees B Higgins and R Pickett 2018 $90.00
Pickett Pickett
1207 101 bill(s)is(are)true and correct and that the 1207 101
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, October 22,2018
Y
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
I •
Page 1
2019 INDIANA PESTICIDE COMMERCIAL APPLICATOR RENEWAL APPLICATION
I
I
ROOKSHIRE GOLF CLUB
2120 BROOKSHIRE PARKWAY
ARMEL IN 46033-1212 Current Phone: (317)846-74311 Ext.
Current Fax:
Business e-mail: bhiggins@carmel.in.gov
i
bmit the_8e_rL at pp_I).c_atto.in the enclosed envelope before December 31 2018.Those
applications postmarked after December 31,bylaw,require an additional'!00%late fee-penalty.
Certification in each category is valid for a five(5)year period.
NOTE: A license and technician registration is renewed each year prior to Dece er 31.
License Number= N35567 FEE=$45.00 RENEW DO NOT RENEW
ROBERT DAVID HIGGINS Personal e-mail:bhiggins@carmel.in.gov
Category 3A 3 CCHs earned out of 15 required Category Expires 12/31/2020
Category 3B 7 CCHs earned out of 20 required Category Expires 12/31/2022
License Number= RT271062 FEE_$45.00 EW DO NOT RENEW
RUSSELL EUGENE PICKETT Personal e-mail:
Category RT 0 CCHs earned out of 8 required Category Expires 12/31/2022
Total Fee Due:$90.00
Submit the Renewal Application In the enclosed envelope before December 31,2018.Those
applications postmarked after December 31,bylaw,require an additlonal 100%late fee penalty.
i
Send to: Office of Indiana State Chemist,Purdue University,175 S.University St. West Lafayette,IN 47907-2063
Make check payable: Indiana State Chemist
I hereby swear and affirm that the list being submitted is a true and accurate record of the!current certified employees working _
at this business location.I also acknowledge that failure to provide accurate information on this application
form constitutes a violation of the Indiana Pesticide Use and Application Law(IC 15.3-3.6; Section 65(11)).
•
I
Printed a Job title of person signing
Signature Date
i
**** FOR STATE CHEMIST OFFICE USE ONLY ****
APPROVED DATE
I
Check No Amount Entered Under
I
v_License# GN30022 Posted Account#
RT PAL
i
FAL Amount
Total Fee Due:$90.00
i