HomeMy WebLinkAbout193802 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURIT AMOUNT: $120.00
CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY- FISCAL OFFI
302 W WASHINGTON ST, RM E221 CHECK NUMBER: 193802
INDIANAPOLIS IN 46204
CHECK DATE: 1119/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4358300 734241122720 120.00 734241 12272010 -1
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CARMEL /CLAY BOARD OF PARR RECREATION 1411 E 11 6TH ST CARMEL IN 46032
1.If Code An annual test report is due before a ermit is issued.
2.If Code A 5 year Test report is due before a permit is issued.
3.Over 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 Due Over Due Location Address
111703 $120.00 0.00 1235 CENTRAL PARR DR EAST, CARMEL IN 40632
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Purchase
Description
P.O. P or F
G.L.# 1- 5�� DEC 2 8 2010
Bud et I �s
Line Descr
BY
Purchaser Date I
Approval Data tQ 1 I
Reference Number Invoice Date Please ENTIRE document with payment
734241- 12272010 -1 12/27/2010 Unit(s) 1 Total Due upon receipt
of 1 120.00 of 120.00
Ref.Num.:734241- 12272010 1 $120 of 120.00 Invoice Date 12/27/2010
If Paying by check, include a check made payable to the Department of Homeland
security. If Paying_by_American Express /Discover /Master Card, complete the following
information and return by mail :Indiana Department of Homeland Security, Fiscal
Department, 302 W.Washington St., Rm E221,Indianapolis, IN 46204 or fax to (317)233
0401. Questions? call(317)232 -6427 or E- mail :elevator- invoice@dhs.in.gov
2.25% convenience fee charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
Credit Card: American Express /Discover /Master Card ONLY (circle one)
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'i
Acct. Number Exp.Date (mm /yy)
f CVV2 Number Contact Phone Number Signature
By signing, cardmember agrees to the obligations set forth by the Cardmember's
Agreement with the issuer.
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
229400 Indiana Department of Homeland Security Terms
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
12127//0 73424111292010 Elevator permits 120.00
Total 120.00
1 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. Warrant No,
229400 Indiana Department of Homeland Security Allowed 20
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204 In Sum of
120.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #MTL AMOUNT Board Members
Dept
1091 73424111292010 4358300 120.00 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
13 -Jan 2011
6Ld
Signature
120.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund