HomeMy WebLinkAbout331761 10/30/18 ! CITY OF CARMEL, INDIANA VENDOR: 074600
• ONE CIVIC SQUARE DEPT OF NATURAL RESOURCES CHECK AMOUNT: $*******100.00*
CARMEL, INDIANA 46032 DIVISION OF WATER CHECK NUMBER: 331761
402 W WASHINGTON ST W264 CHECK DATE: 10/30/18
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 MASCARI 100.00 OTHER EXPENSES
VOUCHER NO. 183129 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor# 74600 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
DEPT OF NATURAL RESOURCES CITY OF CARMEL
DIVISION OF WATER An invoice or bill to be properly itemized must show: kind of service,where performed,
402 W WASHINGTON ST W264 dates service rendered, by whom, rates per day, number of hours, rate per hour,
INDIANAPOLIS, IN 46204-2641 numbers of units, price per unit,etc.
Payee
100.00 74600 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR DEPT OF NATURAL RESOURCES Terms
Carmel Water Utility DIVISION OF WATER Due Date
BOARD MEMBERS 402 W WASHINGTON ST W264
I hereby certify that that attached invoice(s), INDIANAPOLIS, IN 46204-2641
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
MASCARI 01-6040-03 $100.00 and received except 10/24/2018 MASCARI $100.00
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20—
Clerk-Treasurer
APPLICATION FOR WATER WELL DRILLING LICENSE Return to:
INDIANA DEPARTMENT OF NATURAL RESOURCES
AND PUMP INSTALLER LICENSE
f\ DIVISION OF WATER
State Form 417(R3/11-10) 402 W.Washington St.,Room W264
Approved b State Board of Accounts,2010
pp y Indianapolis,IN 46204-2641
The provisions of IC 25-39 require anyone who operates water well drilling or driving equipment and engages in the drilling of
water wells, or the installation or service of water well pumping equipment in Indiana to have a valid Indiana Water Well
Drilling or Pump Installer License. To qualify for an Indiana water well drilling license or pump installer-license, an applicant
must be at least eighteen (18) years of age, successfully complete a competency examination, and provide three reference
statements to the Division of Water, of which at least two must be from a licensed water well driller/pump installer or a
licensed plumber. (IC 25-39-3-3).
Full Name: .�D� ✓1 i
l!(First) (Middle) (Last)
Business Address: L..- �� Th s
(Street or Rural Route)
71
(City) (State) (ZIP code)
Office Telephone Number: )f 7 7.33—2-V'S-5— Email Address: J'Ma S"-
(Include area code) �L
Date of Birth: � 7� —(e�'2—
Type(s)
Type(s) of Equipment Operated or Installed: „`Q� /' '14 I-le
/ I-le loam P5
Number of Years Operated:
Employment History (as a water well driller or pump installer):
Company Name Company Address Employment Dates
62-
The
ZThe annual fee for a water well drilling/pump installer license is one hundred dollar ( 100) r a calendar year;whether it is
for one or both endorsements. Please make your check or money order payable a DEPARTMENT OF NATURAL
RESOURCES (or simply DNR).
! hereby swear or affirm under the penalties for perjury that the information submitted herewith is, to the best of my know-
ledge and belief, true, accurate, and complete.
Signature: G��/'��' Date:
Name of Company: Clc 171 n Ala
Note: An application for an original license is not complete until three(3)reference statements are completed and received by the Division of Water.
FOR ADMINISTRATIVE USE ONLY
Date Application Was Received: Application No.:
License Number Issued: Issued By: