164758 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
1 4 ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $50.00
CARMEL, INDIANA 46032 P 0 BOX 1910
CARMEL IN 46082
CHECK NUMBER: 164758
'M CHECK DATE: 10116/2008
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPT
209 4347500 NOTARY 50.00 NOTARY -BASS
Do Not Write In This Box For Office Use Only
Commission# Expiration Date ofNew Commission
APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STATE OF INDIANA
Complete and Return to: Notary Department, Secretary of State, Room 201, State House
Indianapolis, Indiana 46204: Telephone: 317- 232 -6542
To: THE GOVERNOR OF INDIANA
I respectfully request that 1 be appointed and commissioned a Notary Public. In support of my application, I submit herewith the required bond,
oath of office, and fee of FIVE DOLLARS ($S), payable to the Secretary of Stale, in theform of a check or money order. (Do not send currency in
the mail.) (IC 33- 16 -2 -1)
PRINT OR TYPE
I. NAME A. ELAINE BASS
y egal sipatura is v1d de commission will be issued -sm instrnaioa 93
2. HOME ADDRESS 8832 ar�astut
Indianapoli T diana 4625pcda
cry
3. COUNTY OF RESIDENCE Marion
4. Business or Employer's Name _Citv of Carmel
5. Business or Employer's Address One Civic Square Carmel Indiana 46_2
su at Ciw SM
6.. HOMEPHONE (317 845 -5182 OFFICE PHONE (317 571 -247
Am C, Nusnbet
7. If you have a current valid notary commission, show your expiration date:
October 23
8. If you are now a notary public and your name or county has changed since your last application, please give both old and new information.
OLD:
NEW:
R. NOTARIAL OATH
STATE OF INDIANA
SS:
COUN OF
HAMILTON
TY
puny in wrme Is ouster
I do solemnly swear (or affirm) that I will support the Constitution of the United States, and the Constitution of the State oflndiana; that I am duty
qualifiedto hold office under the Constitution and laws of the State; that I am 18 years of age or over, that] am of good moral character and integrity,
that I am a resident of Indiana; that my answers to questions on this application are true and complete to the best of my knowledge; that I have
carefully read all of the instructions which came with this application, and that I will faithfully and impartially discharge the duties of NOTARY
PUBLIC if so commissioned by the Governor, according to the best of my skill and ability, so help me God (or under the pains and penalties of
perjury)
�{J� Si tore o appli
P1eccof6cers seat Hero Subscribed and sworn or affirmed to before me, thisa day of (PLC
A IN TESTIMONYWHEREOF,I, Carla J. Newcomer paned or typed mme ofoffimr
a Notary Public forthe
s4maw=Oran puh5em• athero >TeerauthonadmadministerOAS C
County of Boon Stateoflndiam
OI'6arsaamy ofresda,a
My commission expires: March 12, 2016
NOTE: The Bond Form, starting with 010 on the back of this application, must be completed before mailing to the Secretary of State.
The applicant must sign again in #10.
f
10. NOTARIAL BOND
KNOW ALL BYTOESE PRESENTS, that we A. Elaine Bass as principal
Name of Ay wu
(applicant) and of
N ame of Srmty
and County as
trrrt address, eay, sram code
freehold or corporate surety, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the
payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents.
WITNESS our signatures as acknowledged below. THE CONDITION OF THE ABOVE OBLIGATION IS AS FOLLOWS,
TO -WIT.
WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a
Notary Public, in and for the State of Indiana, for a eight -year term.
Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to
law, then the above obligat' a to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective
date of the princ ip 's icsieato the expirgoh date of the same.
Si o appliemt. dmvin On xgnwmorsmety. Must beedmawh:dgedbefmin#12
11. ACKNOWLEDGEMENT OF AP ICAN!''S SIGNATURE BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY
LAW TO TAKE ACKNOWLEDGEMENT'S.
STATE OF COUNTY OF SS:
CbwrW is wrnc admw+lcdganrnt is tuaog made
Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk etc.) personally appeared
A. Elaine Bass and acknowledged the execution of the foregoing bond for the uses and
Ported ortyped mmeofapp
purposes therein expressed, without condition or reservation.
Piaoe officer': scar h= 1N TESTIMONY WHEREOF, I QX JV+�L..1 CO rn have hereunto set my
Pn m e �ietr p
hart nd official seal, this day of
a AIAWy�u,b il
signor radatriM o ce
for the County of State of
te(so,mty ofraidmea
My commission expires: �/L� —I /oZ d/ b
12. ACKNOWLEDGEMENT OF SURETY'S SIGNATURE (Freehold or Corporate) BY A NOTARY PUBLIC OR OTHER OFFICER
AUTHORIZED BYLAW TO TAKE ACKNOWLEDGEMENTS. (NOTE. The officer can not acknowledge hip*er own signature)
STATE OF COUNTY OF SS
CounLyiawhicbacknawltdgementss Dang made
Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc) personally appeared
and acknowledged the execution of the foregoing bond for the uses and
Pants ortyped name of imhvi dual stgung as suety
purposes therein expressed, without condition or reservation.
Nam officer's seai here IN TESTIMONY WHEREOF, I have hereunto set my
Panted er nmreofofftca
hand and official seal, this day of 20
a
s4porme of mmomed affamr at5eo
for the County o f State of
Of6ca(smnntyo r6rdrncc
My comet ission expires:
13. SUPPORTING AFFIDAVIT TO BE USED IN SUPPORT OF A FREEHOLD SURETY.
STATE OF INDIANA, COUNTY OF SS:
owrty in which ec vddgement fs berog made
The undersigned surety, being duly sworn or affirmed, says that he/she is the owner in fee simple of Real Estate in
County, of the fair Cash Value of over and above all
encumbrances and exemptions. simtamraorsnay
Place Offioerts sear dery IN TESTIMONY WHEREOF, I have hereunto set my
PnrHd or mmeof oaiec
hand and official seal, this day of 20
a
g== of Wtb ldo JiGr o
for the County of State of
Of6ce(s munry o residmea
My commission expires
For the statute Pertaining to surety company bonds, see Indiana Code 27 -1 -22. For the statutes pertaining to Officer's Bonds and
Oaths, see Indiana Code 5-4.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Hylant Group of Indianapolis
Purchase Order No.
501 Congressional Blvd., Suite 300
Terms
Carmel, Indiana 46082 -1910
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10 -2 -08 Notary Bond for A. Elaine Bass per the attached $50.00
Application or Appointment As A Notary Public
In The State Of Indiana
Total
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.
ALLOWED 20
Hvlant -Group of Indianapolis IN SUM OF
501 Congressional Blvd., Suite 300
Carmel, Indiana 46082 -1910
50.0
ON ACCOUNT OF APPROPRIATION FOR
DEFERRAL FEE FUND
430 -47500 General Insurance
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
209 $50.00 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
20 0
S nature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund