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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 zljr VaI UA UY Clutl LLVV LZAI LZ L 1i 1L L1X VU1VG 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 i t 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) r '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. F f 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