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HomeMy WebLinkAbout156629 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1 ONE CIVIC SQUARE HYLANT GROUP CARMEL, INDIANA 46032 P 0 BOX 1910 CHECK AMOUNT: $50.00 CARMEL IN 46082 CHECK NUMBER: 156629 CHECK DATE: 2/21/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1180 4347500 LAW 50.00 GENERAL INSURANCE Do Not Write In This Box For Office Use Onl Commission# Expiration Date of New Commission APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STATE OF INDIANA t 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 I 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 ($5), payable to the Secretary of State, in the form of a check or money order. (Do not send currency in themail) (IC33- 16 -2 -1) PRINT OR TYPE 1. NAME Carla J. Newcomer Your legal signature i n wbi ch cotnmiss ion will be issued -s= instruction #3 2. HOMEADDRESS 8991 Shelburne Way Number and succi Zionsville, Indiana 46077 City Stare 21P mde 3. COUNTY OF RESrDENCE Boone 4. Business or Employer's Name Carmel City Attorney 5. Business or Employer's Address One Civic Square Carmel Indiana 46032 street city state ZU` code 6. HOMEPHONE 317) 769 -4439 OFFICE PHONE (317 571 -2473 Arm. Code Numbar Area Cole Number 7. If you have a current valid notary commission, show your expiration date: 20 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: 9. NOTARIAL OATH STATE OF INDIANA SS: COUNTY OF hm /L T D A County to which oxh is administered I do solemnly swear (or affirm) that I will support the Constitution of the United States, and the Constitution of the State of Indiana; that I am duly qualified to hold office under the Constitution and laws of the State; that I am 18 years of age or over; that I 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). Signature of applicant Place Officer L l s Seal Here Subscribed and sworn or affirmed to before me, this day of �z14 A.D. 2042' IN TESTIMONY WHEREOF, I, A L JJ E L9 c J" C VY tinted or typed name of. iiioer t/L C for the S ignatum of a notary public err of her office auil,ori ad to administer oxhs office County of .3 State of Indiana. Oft¢ls county orresidme, My commission expires: U C 708 NOTE: The Bond Form, starting with #10 on the back of this application, must be completed before mailing to the Secretary of State. The applicant must sign again in #10. 10. NOTARIAL BOND KNOW ALL BY THESE PRESENTS, that we No as principal me of Applicant (applicant) and of Name of Surety Strce( address, city, s tae &ZIP code and County as 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. I 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 obligation 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 cipal's co ion the expiration date of the same. Signature ofappl' t. Must be acknowledged below i a# 11 Signatumufsurety. Must beadmowledged below in #12 11. ACKNOWLEDGEM NT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. STATE OF /�D %ANI� COUNTY OF iltf mlz_ SS: County in which admowledgancnt is being made Before me the undersigned, a n officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk etc.) personally appeared /YL-ZU C D M C" and acknowledged the executi on of the foregoing bond for the uses and Prin or typed no= of applicant purposes therein expressed, without condition or reservation. Place Officer's seal here IN TESTIMONY WHEREOF, I LZ/4 %NE A4 5; have hereunto set my Pti OW or typed name of officer hand and official seal, this K day of 4 (%412 Signature of authorized officer office for the County of f (4X 0 A) State of T I) A1A Offi- escount ofrcsidenu My commission expires: C2 C ?i, _,70© Q 12. ACKNOWLEDGEMENT OF SURETY'S SIGNATURE (Freehold or Corporate) BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. (NOTE. Tire officer can not acknowledge his/her own signature) STATE OF COUNTY OF SS: County in which acknowledgment is being made Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc) personally appeared Printed or typed name of individual signing as surety and acknowledged the execution of the foregoing bond for the uses and purposes therein expressed, without condition or reservation. Place officers seat here IN TESTIMONY WHEREOF, T P have hereunto set my Printed or typed namcof o�ca hand and official seal, this day of 20 a Signature of authori -d offioer office for the County of State of Officers county of rs idmce My commission expires: 13. SUPPORTING AFFIDAVIT TO BE USED IN SUPPORT OFA FREEHOLD SURETY. STATE OF INDIANA, COUNTY OF SS: County in which xknowledgement is being 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 S over and above all encumbrances and exemptions. signaturcofaurcry Place Officer's seal here IN TESTIMONY WHEREOF, I_ Printed or typed W have hereunto set my ane of ofrica hand and official seal, this day of .20 a Signature of outhor¢od officer office for the County of State of Officers county ofrsidmce 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)) 2 -13 -08 Notary Bond for Carla J. Newcomer per the attached $50.00 Application For Appointment As A Notary Public in The State 01 111dicilld Total 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Hylant Group of Indianapolis IN SUM OF 5 01 Congressional Blvd., Suite 300 Carmel, Indiana 46082 -1910 50.00 ON ACCOUNT OF APPROPRIATION FOR Department of Law 430 -47500 General Insurance Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1180 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 nature Cost distribution ledger classification if Title claim paid motor vehicle highway fund