192405 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 00351564 Page 1 of 1
ONE CIVIC SQUARE GARY CARTER CHECK AMOUNT: $15.00
z CARMEL, INDIANA 46032 4748 BISHOPSGATE DR
'L +roa z� CARMEN IN 46032 CHECK NUMBER: 192405
CHECK DATE: 121712010
DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
1120 4358300 15.00 OTHER FEES LICENSES
I
INDIANA CERTIFICATE OF VEHI REGISTRATION STATE FORrrt (I 11991 APPROVED BY STATE BOARD of ACCOUNTS 1996
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N Q9 $4231 MO NU EXP G 0.00 0.00 0.00 0.00
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08 GMG VA C4V 1GDE4V1978F418435 RED! 1012811Q N "':x OAO D.00 Q.QQ 0.00
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.11 HAMILTON Gla E 803 Q$032190084
IMPORTANT: REGISTRATION MUST BE SIGNED TO BE VALID TRAWLERS rl INS URANCE w11�t1, 01U0
swear or affirm under penalty of perjlny that the staternents made heroin are IN
correct- 1 am now providing proof o1 financial responsibility for this vehicle and —1 "'1'
affirm that insurance will he continuously maintained during the registration period. GPO931 O.QQ
Additi tax an dlor fees may h e due it an error is ma de- N n.l tl+
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CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL, IN 46032
fPWR Bureau of Motor Vehicles
w Detailed Transaction Receipt
BMy State Form 51714 (4 -04)
F
Branch: VEHICLE SERVICES REGISTRATIONS Date: 11/15/2010 Time: 15:55 EDT
Visit ID: 162126405 CSR: LJ
Visit Customer: CITY OF CARMEL
Transactions
Trans IDTrans Type Trans Subtvne Amount
185432073 Title Initial Title Issuance New
Title Fee Vehicle $15.00
Vehicle: 1GDE4V1978F418435 2008 GMC C4V YY
Lien Holder: THE HUNTINGTON NATIONAL BANK
105 E 4TH ST CN01
CINCINNATI, OH 45202 -4009
Customer: CITY OF CARMEL
Purchase Date: 10/28/2010
$15.00
Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1
APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES
State Form 205 (R716 -04) Approved by State Board of Account 1997
TO BE COMPLETED BY A POLICE OFFICER, BMV OFFICIAL OR BMV CERTIFIED DEALER SIGNEE INWE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA-
FOR OUT OF STATE TITLES. I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING TION ENTERED ON THIS FORM IS CORRECT, IIWE UNDERSTAND
VEHICLE AND FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS. THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI-
VEHICLE IDENTIFICATION NUMBER 7UTE THE CRIME OF PERJURY. FUTHERMORE, I/WE AGREE TO
J I INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY
R MAKE MODEL TYPE DATE LIABILITY ARISING FROM THIS TRANSACTION.
X
X
INSPECTOR'S PRINTED NAME TITLE CITY
DATE:
INSPECTOR'S SIGNATURE BADGE, BRANCH OR The law requireslhal you apply forCedifCateofTitle within thiny -one days from the defeat purchase ofa
molor vehicle. There is a delinquent fee of 421.00 for failufe to do so. Attach Certificate of Title assigned by seller. On en-
DEALER PLATE NO. dorsed Titles, liens must be released. Supporting documents surrendered with this application cannot be returned to the apprr
cant. Slate fee for applying for Title is415.00. 1n accordance with Federal Code 383.
TITLE NUMBER BRANCH NO INVOICE NO BMV USE ONLY
1. 11151080300009 803 MV- GOVERNMENT CERTIFICATE OF ORIGIN
'SOC. SEC. /FEDERAL I.D. NO APPLICANT'S NAME BMV USE ONLY D
2. CITY OF CARMEL 0
STREET ADDRESS CITY STATE ZIP CODE N
3. ONE CIVIC SQUARE CARMEL IN 46032 0
VEHICLE I.D. NUMBER VEH. YEAR VEH. MAKE VEH. MODEL NO. VEH. ACTUAL
TYPE ODOMETER T
4. 1 GDE4V1978F418435 2008 GMC C4V VA 304 M T
FORMER TITLE NUMBER I PURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y
5. C OF O 10/28/2010 1 No No Yes E
FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS
6. THE HUNTINGTON NATIONAL BANK 105 E 4TH ST CN01 N
CITY STATE ZIP CODE BMV USE ONLY
7 CINCINNATI OH 45202 -4009 T
H
SECOND LIEN'S NAME STREET ADDRESS
8. s
CITY STATE ZIP CODE LICENSE NUMBER LICENSE FORMS BMV USE ONLY A
L
9 YEAR USED R
E
GROSS RETAIL USE TAX AFFIDAVIT IIWE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW A
SELLING PRICE LESS TRADE-IN DISCOUNT AMOUNT SUBJECT 70 7A AMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPT
10 0.00 0.00 0.00 0.00 X PLACE
PA
RA.ff
Your Social Security number Federal I.D. number is being requested by this agency under IC 4-1-8-1. Disclosure is mandatory and this document cannot be processed without it.
APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION
APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES
II VIII VIII III II IIII VIII l ii l 111 1111111111111 lllll 111
2 0 5 1 8 5 4 3 2 0 7 3
FIFTH THIRD B ANK
Account Number Ending
MASTERCARD PLATINUM October 21, 2010 to November 20, 2010 page 3 of 4
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Reference Number Trans Date Post Date Description of Transaction or Credit Amount
...,ga.., �'r' aa -s�
=..„.2 t'''M afik��. €.,'r^sd &C r'dlt5fi. 3� :«iu w�s"'t,:;r
6806 11103 11103
11 .E a W F z Purchases Cash Aduancesr& pfher;Charges,.�. r1 r
au� d> ,.�".r d�"�...u;:, C a�zi<7 .1 �:,ai.. xs...e,:���. e'�r_. �a� tiza�
02955225 10121 10122 IN
03021328 10129 11/01
03111666 11106 11/08
03209950 11/16 11116 L2G`IN BMV BRANCH 9803 888- 692 -6841 IN $15.00
r a ir c
b 92,1314 Totals Year to Date 3
Total fees charged in 2010
Total interest charged in 2010
Your Annual Percentage Rate (APR) is the annual interest rate on your acco
9 y, w. �q x '""7..., zr ''b C �Aa" '€ta5 u' f Fa s a•;` >y r.
s, �s�igam �A, nnual.f?ercenta erRate' a
E Balance Sub ect to a x� o
,a.. d tw .p.,7 ::'a e y,.g,;; �d �'3� C e I,. 4 a ,s, d"' k r r
TYPe Balance f� s (AF'R ry :Iiterest Rate?
d n P �I€ h e' x l I,r �a Fry .3 nterest Charge
?'Sa �Yvan.t�.,, «.x. ,r .,ez,� x.. `.:5 ;;�a h.mrmaw�� a �.�c, 's., "ar'rs '.ib 5 �€.x. m.a,�3, Gm .,;..i,
Current Purchases` 10.99% (v) $0.00 $0.00
Current Cash 24.99% $0.00 $0.00
Z
(v) Variable Rate
`ff you have a Promotion, the balance may include but is not limited to Balance Transfers, Convenience Checks and other various promotional interest rate
offers.
z
LL
Previous Rewards Balance 6,69 g
VOUCHER NO. WARRANT N O.
ALLOWED 20
Gary Carter
IN SUM OF
$15.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept, INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 583.00 $15.00 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
DEC 6 201
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Title Fee New Ambulance $15.00
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
2a
Clerk- Treasurer