334323 01/10/19 CITY OF CARMEL, INDIANA VENDOR: 229400
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIIRI'IECK AMOUNT: S*******120.00*
CARMEL, INDIANA 46032 FISCAL DEPT CHECK NUMBER: 334323
MUTON�. 302 W WASHINGTON ST,ROOM E221 CHECK DATE: 01/10/19
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4239099 120.00 734241122620181
. . . . .
ACCOUNTS-PAYABLE.VOUCHER
CITY.OF CARMEL.
VOUCHER NO. WARRANT NO.
An invoice of bill to be prop'erly.itemized must show;kind of service,where performed,dates service rendered,;by
Vendori. 229400 Allowed. 20 whom;.rates per day,number of hours,'rate'per hour;.number of'units,ptice'per unit,etc.
Indiana Department of Homeland Security Payee
Fiscal De artment , , '
302*W, Washington St.,:Rm•E221 In Sum•of$ Purchase order.#
Indianapolis, IN :46204: 229400 Indiana Department of Homeland Security : . Terms
$. 120:00 Fiscal Department: : . Date Due
302'W Washington St,Rm E221
ON ACCOUNT OF APPROPRIATION FOR_ Indianapolis,IN 46204
109-Monon Center ..
PO#or Invoice Description
INVOICE No.-- ACCT#rrlTI_E AMOUNT -
tiepf# - .. Invoice Date Number (or note'attached.invoice(s)or bill(s)) PO#' Amount '
1093 734241122UO181 :4239099. $ 120.00 Board Members 12/26/18. 734241122620181 Annual Elevator Permits 20.19. 52221. $ 120.00
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.
$. 120.00. . total $ -120.00•
. . . . . . . . . January 3,2019'
I hereby certify that the attached invoice(s),'or bill(s)'is(are)true and correct and l have audited same in accordance
with 16 5-11-16-1.6
Cost distribution ledger classification if
claim paid motor vehicle highway fund signature.. 20
Accounts Payable Coordinator. . — Clerk-Treasurer.
Title
--- ------ - - - - ----- - -- ---------
ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL CLAY PARKS & RECREATION 1411 E 116TH ST ACCOUNTS PAYABLE CARMEL IN 46032
1.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.
3.0ver 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
111703 $120.00 $ o.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632
DEC 3 12018
BY:
FtRef%en-d"e,i�,Number
Elnvoipce-DatePlease submit ENTIRE document with payment
34 _]12262018 =1 /26 2018 Unit(s) 1 Total Due upon reaeiptry
of 1 $ 120.00 of� $ `_120.;0-0
Owner Id 734241
Ref.Num. :734241-12262018 - 1 $120 of $ 120.00 Invoice Date 12/26/2018
If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your
payments online at IDHS web site https://oas.dho.in.gov/dfbe/idhaFeesFines/start.do with Visa/Master
Card/Discover cards. Use Owner Id on this letter or State Number on the invoic pill;up--informat-ion-when
K-
p,re1 ty-,-F scaLpea-rL ent, 302 W Wa ington St. Rm 5221.,.Indy,—"'I" INS otm at�of
a�r.�i,n the-dues-oaline.OR com late the followin inform_ation_and-return b mai b d ana- a ar
HO and'S ctiir �i fax to
(317)233-0401. Questions? call(317)232-6427 or S-mail:elevator-invoice®dhe.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. :734241-12262018 - 1 $120 of $ 120.00 Invoice Date 12/26/2018
---- - ---- ----- ---------------