HomeMy WebLinkAbout185794 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIT AMOUNT: $35.00
J
CARMEL, INDIANA 46032 DIVISION OF ELEVATOR SAFETY
302 W WASHINGTON ST, RM E221 CHECK NUMBER: 185794
INDIANAPOLIS IN 46204
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 35.00 BUILDING REPAIRS MA
"fr INVOICE FOR INSPECTION CERTIFICATE FEES
T e State Form 356 (R4 9 -93)
Approved by the State Board of Accounts 1991
GS•
Division of Fire and Building Safety
1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
2. Mail 2nd copy 8 check to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
INDIANA LATEST PLEASE
NUMBER CARMEL CITY OF INVOICE PAY THIS
W DATE AMOUNT!
311211 3 CIVIC SQ
1
CARMEL, IN 46032 04/30/2010
Owner number User Name Location of vessel POLICE DEPT Fee
3 CIIVC SQ 35.00
CARMEL IN 46032
Serial number Description of vessel Manufacturer Date Last Inspected
9991 SERVICE WATER HEATER LOCHINVAR 04/20/2010
National Board No. Inspection agency Name of inspector (This fee is
STATE OF INDIANA PARKEY LARRY E prescribed by
675IAC 12 -3 -13)
Inspection Date Inspector Name Inspection 'type Due
04/20/2010 PARKEY LARRY E FIRST INSPECTION -B- 311211,04/30/2011 35.00
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Department of Homeland Security Purchase Order No.
Boiler Pressure Vessel Safety Division
302 W. Washington Street, Room 246 Terms
Indianapolis, IN 46204 -2739
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/30/10 a ent for water heater inspection 35.00
Total
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
Clerk Treasurer
VOUCHER NO. NO.
ALLOWED 20
D epartment of Homeland Security IN SUM OF
Boiler and Pressure Vessel Safety Division
302 W. Washington Street, fo6m -246
T ndianapolis, IN 46204 -2739
35.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# or INVOICE NO. ACCT# /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 501 35.00 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
May 13 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund