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HomeMy WebLinkAbout188763 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 00351684 Page 1 of 1 ONE CIVIC SQUARE CLERK OF THE COURTS ANNUAL FEES CHECK INDIANA 46032 P O BOX 6069 DEPT 179 CHECK AMOUNT: $390.00 INDIANAPOLIS IN 46206 -6069 CHECK NUMBER: 188763 CHECK DATE: 8/18/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1160 4355300 STMT 130.00 ORGANIZATION MEMBER 1180 4355300 STMT 260.00 ORGANIZATION MEMBER Clerk of the Supreme Court INDIANA SUPREME COURT ,o•,r- -�.r� Court of Appeals, and Tax Court 200 W. Washington St., Rm. 216 2001/ n Indianapolis, IN 46204 2795f( l }yl•• PHO: 317 -232 -1930 A �j n� @court S��W ll O N STATEMENT Cl Il FAX: 2-8365 clerk @courts.state.in.us D 0 91 I 0 4 Row Mailing Address Additional Contact Information o WM mgazAgaumb ffi Dw MR DOUGLAS HANEY 13828 SMOKEY RIDGE DRIVE CARMEL, IN 46033 -0000 1 CIVIC SQUARE CARMEL, IN 46032 Phone: 317- 571 -2472 Fax..: 757 124 -8400 Email: dhaney@carmel.in.gov �1 r�i OG° HEV SUL MS AND FEEZ CURRENT STATUS ATTORNEY NUMBER PASSWORD Active In Good Standing 11207 -49 i LECOEHLR DESIRED n u -o o a o •o o D o 0 0 0 o •o 0 ATTORNEY STATUS BELOW i fictive /Good Standing $130.0 210:a0 X60.00 410.00 Inactive /Good Standing 65.00 115.00 165.00 165.0 Retired 0 .00 0 .00 $0 ;QO $0.00 There alre two ways t® wake yo uur payment: Return this statement and a check made payable to "Clerk of Courts Annual Fees (p.°p (Address for annual fees mailed in (Address for annual fees personally delivered %b 9 P Clerk of the Courts Annual Fees Clerk of the Courts Annual Fees Qgt, cV Flu P.O. Box 6069 Dept. 179 402 W. Washington St., Rm. W062 usm ft Mmm Indianapolis, W 46206 -6069 Indianapolis, IN 46204 1 1° QOoG°3® lip em ft Pay your annual f4and update your contact information online. Go to a @0&(W T& @MMM http: /courts.IN.gov /co /li cense_ a_ nd Log with your att numb and password printed at the top of this section. i A convenience fee of $3.50 plus 2% of your total attorney fee due (including any penalty for late payment) is charged for credit card payments. AIFFO DDAWO4 OF 0HAC40M0'ffV OR RET EHENY I wish to place or retain my Indiana law license in inactive status. I wish to place my Indiana law license into retired status. I am currently I am currently in either active or inactive good standing status. in either active or inactive good standing status. I neither hold judicial I neither hold judicial office nor engage in the practice of law in office nor engage in the practice of law in Indiana. I am at least 65 years Indiana. I understand that this status carries a reduced annual old. I acknowledge that this status, which carries no registration fee, registration fee of $65.00 but may include late fees if tendered exists for attorneys who do not plan to return to the practice of law. after October 1 of the relevant registration year. I am current in my Indiana CLE obligations. I swear or affirm under penalties of perjury that the foregoing statements regarding my inactivity or retirement status are true. Date: Signature: Please see reverse side. 0 IMPORTANT! IF ACTIVE ATTORNEYS DO NOT COMPLETE THE IOLTA CERTIFICATION, THE STATEMENT AND CHECK WILL BE RETURNED, THE ANNUAL ATTORNEY REGISTRATION WILL BE INCOMPLETE AND A LATE FEE MAY BE ASSESSED. REQUIRED IOLTA CERTIFICATION' Please check one of the following: I /my firm participate(s) in Indiana's IOLTA program. Indiana IOLTA Account Financial Institution: IOLTA Account Number: Please attach information on additional IOLTA accounts to this form. I /my firm maintain(s) an IOLTA account in a state other than Indiana. 1 am exempt from maintaining an IOLTA account because: El I am not in the private practice of law, or my practice does not involve Indiana client trust funds, or I do not have an office within the State of Indiana. I am a judge; an attorney employed by a local, state, or federal government; on duty with the armed services; a corporate counsel; or a teacher of law; and I am not otherwise engaged in the private practice of law. Participation in the IOLTA program would work an undue hardship on me and /or would be extremely impractical based on my circumstances, which 1 have outlined on a separate sheet of paper. See Ind. Prof. Cond. Rule 1.15(g)(2)(G). 1 Rules of Professional Conduct Rule 1.15 requires attorneys annually to certify certain information to the Indiana Supreme Court. IOLTA enrollment forms and and information are available at www.inbf.orgor by calling the Indiana Bar Foundation at 317 269 -2415. ATTORNEY SURROGATE DESIGNATION If you engage in the private practice of law in Indiana and do not practice solely as an "employee of a_ partnership, limited liability company (LLC), professional corporation (PC); limited liability partnership (LLP), another lawyer, or an organization not engaged in the private practice of law, then pursuant to Admission and Discipline Rule 23 27(b)(1) you may designate a member in good standing of the Indiana Bar to,a'ct as your attorney surrogate should' you become unable to practice law clue to cleat g y p h,: disappearance, disability, suspension, or disbarment. I hereby designate the following member in good standing of the Indiana bar to act as my attorney surrogate pursuant to Admission.and Discipline Rule 23 27 [NOTE: Partners, shareholders, owners, -and other non -employee lawyers practicing with one or more members of the'.lndiana Bar within partnerships, LLCs, PCs, or LLPs should designate their Fiduciary Entity rather than a °specific attorney —see Admis.'Disc. R. 23§ 27(b)(2)1: Surrogate or Entity: Bar No.: I-certify the above named surrogate attorney has agreed to this designation °in writing and that we both have copies of the agreement-in our pos- sessions. (Designation invalid without this certification.) Date: Signature: OPTIONAL RACE /ETHNIC INFORMATION In an effort to obtain accurate information about diversity within Indiana's legal profession, the Indiana Supreme Court, through its Commission on Race and Gender Fairness, requests that attorneys fill out the following demographic information: GiNil F Male RAGE Caucasian African American Female Hispanic /Latino American Indian /Native American Asian American ❑Other Clerk of the Supreme c ourt, INDIANA SUPREME COURT 0 °4� Q''`!' Court of Appeals, and Tax Court y:ay 200 W. Washington St., Rm. 216 RN EY z Indianapolis, IN 46204 -2795 aj PH0:317- 232 -1930 FAX: 317 232 -8365 Ft' ^�ot x clerk@courts.state.in.us Aftf UAL RE�9STRATI STATEMENT MI? arm ICED Mailing Address Additional Contact Information h kaoft maw g I l MR THOMAS PERKINS II 14150 EQUINE COURT WESTFIELD, IN 46074 -0000 3RD FLOOR ONE CIVIC SQUARE Phone: 317 --571 -2472 o CARMEL, IN 46032 Fax..: 757- 124 -8400 Email: tperkins @carmel.in.gov ATTORNEY .S4AYUS AND FE I CURRENT STATUS ATTORNEY NUMBER PASSWORD Active In Good Standing 18428 -49 QYXZEF6Y DESIGNATE DESIRED o o •o v o v •o 0 0 v •o o v v •a o ATTORNEY STATUS BELOW° a Active Good Standing 130. 210.0© 260.00 410.00 Inactive/ Good Standing 65.00 1,15.00 165.00 165.OQ Retired 0:00 0.00 0.00 $0. 00, There are two ways to make your payment: Return this statement and a check made payable to "Clerk of Courts Annual Fees (Address for annual fees mailed in (Address for annual fees personally delivered WF Clerk of the Courts Annual Fees Clerk of the Courts Annual Fees P.O. Box 6069 Dept. 179 402 W. Washington St., Rm. W062 nt- M= Indianapolis, IN 46206 -6069 Indianapolis, IN 46204 co bmm c>? ft Pay your annual fell and update your contact information online. Go to liter a a h ttp;,( /GOU_ rtS IN.gov /cofc %Iicense_and_ login with_yQur attorney number and_pasSwoCd U- printed at the top of this section. i 1 A convenience fee of $3.50 plus 2% of your total attorney fee due (including any penalty for late payment) is charged for credit card payments. AFFI[DAV07 O F ONACTIVITY OR RETIREMENT I wish to place or retain my Indiana law license in inactive status. 1 wish to place my Indiana law license into retired status. I am currently I am currently in either active or inactive good standing status. in either active or inactive good standing status. I neither hold judicial I neither hold judicial office nor engage in the practice of law in office nor engage in the practice of law in Indiana. I am at least 65 years Indiana. I understand that this status carries a reduced annual old. I acknowledge that this status, which carries no registration fee, registration fee of $65.00 but may include late fees if tendered exists for attorneys who do not plan to return to the practice of law. after October 1 of the relevant registration year. I am current in my Indiana CLE obligations. I swear or affirm under penalties of perjury that the foregoing statements regarding my inactivity or retirement status are true. Date: Signature: Please see reverse side. IMPORTANT! IF ACTIVE ATTORNEYS DO NOT COMPLETE THE IOLTA CERTIFICATION, THE STATEMENT AND CHECK WILL BE RETURNED, THE ANNUAL ATTORNEY REGISTRATION WILL ILFF BE INCOMPLETE AND A LATE FEE MAY BE ASSESSED. REQUIRED IOLTA CERTIFICATION' Please check one of the following: I /my firm participate(s) in Indiana's IOLTA program. Indiana IOLTA Account Financial Institution: IOLTA Account Number: Please attach information on additional IOLTA accounts to this form. I /my firm maintain(s) an IOLTA account in a state other than Indiana. q fam exempt from maintaining an IOLTA account because: I am not in the private practice of law, or my practice does not involve Indiana client trust funds, or I do not have an office within the State of Indiana. �Pam a judge; an attorney employed by a local, state, or federal government; on duty with the armed services; a corporate counsel; or a teacher of law; and I am not otherwise engaged in the private practice of law. Participation in the IOLTA program would work an undue hardship on me and /or would be extremely impractical based on my circumstances, which I have outlined on a separate sheet of paper. See Ind. Prof. Cond. Rule 1.15(g)(2)(G). 1 Rules of Professional Conduct Rule 1.15 requires attorneys annually to certify certain information to the Indiana Supreme Court. IOLTA enrollment forms and and information are available at www.inbf.org or by calling the Indiana Bar Foundation at 317 269 -2415. ATTORNEY SURROGATE DESIGNATION If you engage in the private practice of law in Indiana and do not practice solely as an employee of a partnership, limited liability company (LLC), professions corporation (PC), limited liability partnership (ILLP), another lawyer, or an organization not engaged in the private practice of-law, then pursuant to Admission and Discipline Rule 23 27(b)(1) you may designate a member in good standing of the Indiana Bar'to act as your attorney surrogate should you become unable to practice law due to death, disappearance, disability suspension, or disbarment.. I hereby designate the following member in good standing of the Indiana bar to act as my attorney surrogate pursuant to Admission and Discipline Rule 23 27 [NOTE: Partners, shareholders, owners, and other. non employee. lawyers `practicing with one or more members of the Indiana Bar within partnerships, LLCs, PCs, or LLPs should designate their Fiduciary Entity rather than a specific attorney —see Admis. Disc. R. 23 27(b)(2)]: Surrogate. or Entity: Bar No.: I certify the above named surrogate attorney has agreed to this designation in writing and that we both have copies of the agreement -in our pos- sessions. (Designation invalid without this certification.) Date: Signature: OPTIONAL RACE /ETHNIC INFORMATION In an effort to obtain accurate information about diversity within Indiana's legal profession, the Indiana Supreme Court, through its Commission on Race and Gender Fairness, requests that attorneys fill outthe following demographic information: GENDER. Male RACE: El Caucasian African American Female Hispanic/Latino American Indian /Native American Asian American Other City ��J�r INDIANA RETAIL TAX EXEMPT PAGE Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER A1 FEDERAL 35- 00 0972 EXEMPT d ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. :'URCCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION I I I VENDOR TOIP CONFIRMATION BLANKET CONTRACT It PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION a /'J t t r 1 Send Invoice To: W I' PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT PAYMENT 'd 0 0 A/P VOUCHER CANNOT APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART T OF F THE THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE t h .1': h hul f s AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. DOCUMENT CONTROL NO. 2 6 9 6 0 A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO.� WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OFPROPRIATION FOR CD Hoard Members PO# or INVOICE NO, ACCT #/TITLE AMOUNT I 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 20 o Title Cost distribution ledger classification if claim paid motor vehicle highway fund Clerk of the Supreme Court INDIANA SUPREME COURT Court of Appeals, and Tax Court 200 W. Washington St., Rm. 216 2010/11 ATTOR Indianapolis, IN 46204 -2795 'r�.. PIi0:317- 232 -1930 FAX: 317 -232 -8365 ANNUAL E' iST ATE ENT clerk @courts.state.ln.us Mailing Address Additional Contact Information li ftaloom &gAgRumb MEJD ME C� Pal Tltw moo 35 S 3CaU A ta, MS NANCY HECK CITY OF CARMEL 1 CIVIC SQUARE �IRD 1326 COOL CREEK DRIVE CARMEL, IN 46032 -0000 CARMEL, IN 46033 -2315 Phone: 317 -571 -2494 Fax..: 757 -122 -7800 Email: nheck @carmel.in.gov 'ATTORNEY STATUS AND FEES CURRENT STATUS ATTORNEY NUMBER PASSWORD Active In Good Standing 19106 1 0111"s I I t ti DESIGNATE DESIRED o o •o 0 0 o •o o a o •o 0 0 o •o o i ATTORNEY STATUS BE LOW o Active /Good Standing $13 0.00 230.00 260.00 410.00E Inactive /Good Standing 65.00 115.00 165.00 165.00' Retired 0.00 0.00 0.00 $°0.00, There are two ways to make your payment: Return this statement and a check made payable to "Clerk of Courts Annual l=ees Address for annual fees mailed in Address for annual fees personally delivered Clerk of the Courts Annual Fees Clerk of the Courts Annual Fees P.O. Box 6069 Dept. 179 402 W. Washington St., Rm. W062 uim @MUM at mgmm Indianapolis, IN 46206 -6069 Indianapolis, IN 46204 OR OM @2 ft Q Pay your annual fe and update your contact information online. Go to li a_6 MMMIL- http /courts.IN.gov /cofc /license and login with your attorney number and password m M Gm i=w MOW printed at the top of this section. 1 A convenience fee of $3.50 plus 2% of your total attorney fee due (including any penalty for late payment) is charged for credit card payments. AFFIDAVOT OF ONAC70 /ITY OR RETIREMENT El I wish to place or retain my Indiana law license in inactive status. I wish to place my Indiana law license into retired status. I am currently I am currently in either active or inactive good standing status. in either active or inactive good standing status. I neither hold judicial I neither hold judicial office nor engage in the practice of law in office nor engage in the practice of law in Indiana. I am at least 65 years Indiana. I understand that this status carries a reduced annual old. I acknowledge that this status, which carries no registration fee, registration fee of $65.00 but may include late fees if tendered exists for attorneys who do not plan to return to the practice of law. after October 1 of the relevant registration year. I am current in my Indiana CLE obligations. I swear or affirm under penalties of perjury that the foregoing statements regarding my inactivity or retirement status are true. Date: Signature: Please see reverse side. 19 IMPORTANT! IF ACTIVE ATTORNEYS DO NOT COMPLETE THE IOLTA CERTIFICATION, THE STATEMENT AND CHECK WILL BE RETURNED, THE ANNUAL ATTORNEY REGISTRATION WILL BE INCOMPLETE AND A LATE FEE MAY BE ASSESSED. REQUIRED IOLTA CERTIFICATION' Please check one of the following: I /my firm participate(s) in Indiana's IOLTA program. Indiana IOLTA Account Financial Institution: IOLTA Account Number: Please attach information on additional IOLTA accounts to this form. F] I /my firm maintain(s) an IOLTA account in a state other than Indiana. I am exempt from maintaining an IOLTA account because: I am not in the private practice of law, or my practice does not involve Indiana client trust funds, or I do not have an office within the State III of Indiana. I am a judge; an attorney employed by a local, state, or federal government; on duty with the armed services; a corporate counsel; or a teacher of law; and I.am not.otherwise engaged in the private practice of law. Participation in the IOLTA program would work an undue hardship on me and /or would be extremely impractical based on my circumstances, which I have outlined on a separate sheet of paper. See Ind. Prof. Cond. Rule 1.15(g)(2)(G). 1 Rules of Professional Conduct Rule 1.15 requires attorneys annuallyto certify certain information to the Indiana Supreme Court. IOLTA enrollment forms and and information are available at www.inbf.org or by calling the Indiana Bar Foundation at 317 -269 -2415. ATTORNEY SURROGATE DESIGNATION If you engage in the private practice of law in Indiana and do not practice solely as an employee of a partnership, limited.. liability company (LLC), professional corporation (PC); limited liability partnership (LLP) another lawyer, or an organization not engaged -in the private practice of law, then pursuant to Admission and Discipline Rule 23 27(b)(1) you may designate a member 'in.good standing of the Indiana Bar ta;act as your attorney surrogate should you become unable to practice law due to death, disappearance, disability, suspension, or disbarment., I hereby designate the following member in good standing of the Indiana bar to act as my attorney surrogate pursuant to Admission and Discipline Rule 23 27 [NOTE: Partners, shareholders, owners, and other non- employee lawyers practicing with „one or more members of Indiana Bar within partnerships, LLCs, PCs, or LLPs should designate their Fiduciary Entity than a specific attorney —see Adrinl& Disc. R.'23 27(b)(2)1:. Surro or Entity: Bar No,: I certify the above named surrogate attorney has agreed to this designation in writing and that we both have copies of the agreement in our pos- sessions. (Designation invalid without this certification.) Date: Signature: OPTIONAL RACE /ETHNIC INFORMATION In an effort to obtain accurate information about diversity within Indiana's legal profession, the Indiana Supreme Court, through its Commission on Race and Gender Fairness, requests that attorneys fill out the following demographic information: GENDER:_ Male 7"RACE: Caucasian African American Napl Female Hispanic /Latino American Indian /Native American El Asian American Other V NO. WARRANT NO. ALLOWED 20 Clerk of the Courts Annual Fees IN SUM OF P. O. Box 6069 Dept. 179 Indianapolis, IN 46206 -6069 $130.0 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1160 Statement 43- 553.00 $130.00 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 Monday, August 16, 2010 Mayor Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by Stale 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/01/10 Statement $130.00 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 20 Clerk- Treasurer