156630 02/21/2008 i
CITY OF CARMEL, INDIANA VENDOR: 00352999 Page 1 of 1
ONE CIVIC SQUARE HYLANT GROUP
CARMEL, INDIANA 46032 P o Box 1910 CHECK AMOUNT: $50.00
CARMEL IN 46082
CHECK NUMBER: 156630
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DE
1120 4347500 50.00 GENERAL INSURANCE
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I
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January 25, 2008
City of Carmel
Denise Snyder
One Civic Square
Carmel, IN 46032
Dear Denise:
Enclosed is the Notary Public application you requested. Please complete items 1
through 8 and sign where indicated by the "X" on items 9 and 10. A notary public
needs to complete items 9 and 11.
Please return the completed application to me along with two checks, $5.00 made
payable to the Secretary of State and $50.00 made payable to Hylant Group.
(Please note these charges apply per notary bond.) Upon receipt of the completed
application in our office, we will forward onto the company for issuance.
Please feel free to contact me if you have any questions.
Sincerely,
HYLANT GROUP
Sue Morlock
Enclosure
r`
NOTARY APPLICATION INSTRUCTIONS
1. Application for Notary Public may be obtained from the Secretary of State, the Clerk of the Circuit Court, or a
bonding company. Applications can be photocopied if all parts of the application remain on the front and back of
one piece of paper.
2. The application must be filled out completely. The application must be typewritten or printed.
Do not leave any blanks. If any item is not applicable to you, please indicate that fact with the
words "not applicable" or "none" or "NA".
3. In giving your name in item #I on the application, you should print or type your name the way you will sign your name as a
notary public. Your first or middle name may be initialed, but we suggest either your first full name or your second full name
or both, whichever you prefer. For example: John S. Smith, J. Samuel Smith, or John Samuel Smith; but not J. S. Smith.
Your commission will be issued in the name given in item 91 and when performing a notarial act you should always sign
your name the way it appears on your commission. This requirement is for identification purposes and is for your protection.
4. If you are making reapplication, it is important for you to complete item #7 on the application and show your ex-
piration date so that when your new commission is issued there will be no lapse or overlap. (Ifyour commission has recently
expired, do not show your old expiration date in #7. Show an expiration date only if your commission is still in effect when
you complete the application.) Reapplications should not be sent to the Secretary of State's office earlier than sixty (60) days
before the expiration date.
5. After the first seven items of the application have been filled out, take the application to an officer authorized by law to
administer oaths (e.g. another notary public, the Clerk of the Circuit Court, etc.). The oath of office (item #9 of the
application) will be administered to you by that officer. Be sure to read instructions 96, 7, 8, 9 and 10 below.
PLEASE NOTE: BEFORE TAKING THE OATH IT IS IMPORTANT TO DETERMINE IF YOU ARE QUALIFIED TO BE
A NOTARY PUBLIC.
A. INDIANA LAW STATES THAT IT SHALL BE AN INDISPENSABLE QUALIFICATION FOR PERSONS TO HOLD ANY
OFFICE WITHIN THE STATE OF INDIANA, EITHER BY ELECTION OR APPOINTMENT, THAT SUCH PERSONS
SHALL NEVER HAVE BEEN CONVICTED OF ANY CRIME AGAINST THE LAWS OF THE UNITED STATES WHERE
THE SENTENCE IMPOSED EXCEEDED SIX (6) MONTHS (IC 5- 8 -3 -1).
B. NO PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER THE UNITED STATES OR UNDER
THIS STATE, AND PROHIBITED BY THE CONSTITUTION OF THIS STATE FROM HOLDING MORE THAN ONE
SUCH LUCRATIVE OFFICE, SHALL SERVE AS A NOTARY PUBLIC, AND HIS ACCEPTANCE OF ANY SUCH
OFFICE SHALL VACATE HIS APPOINTMENT AS SUCH NOTARY; BUT THIS PROVISION SHALL NOT APPLY TO
ANY PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER ANY CIVIL OR SCHOOL CITY
OR TOWN OF THIS STATE. (IC 33- 16 -2 -7)
C. EVERY PERSON ELECTED OR APPOINTED TO ANY OFFICE UNDER THIS CONSTITUTION SHALL, BEFORE
ENTERING ON THE DUTIES THEREOF, TAKE AN OATH OR AF IRMATION TO SUPPORT THE CONSTITUTION
OF THIS STATE, AND OF THE UNITED STATES, AND ALSO AN OATH OF OFFICE. (Indiana Constitution, Article
15, Section 4)
6. An official bond, with freehold or corporate security, must be secured in the sum of $5,000. The applicant must
sign in item #10 and have his signature acknowledged in #11. (Freehold security must be approved by the Secre-
tary of State and item #13 of the application is only completed in the case of a freehold bond. A freehold bond is
when someone other than the applicant, who owns land worth at least $5,000, is the surety.) Corporate security
can be obtained by taking the application to a bonding company for completion. Insurance companies and agents
are often qualified to provide corporate security. Items #10, 11 and 12 of the application make up the bond.
7. In the case of a corporate security, a power of attorney showing that the individual signing for the bonding company
has authority to execute the bond should be attached to the application when it is submitted to the Secretary of
State.
S. The completed application, including the oath of office and bond, should be forwarded to the Secretary of State with
a fee of five dollars ($5), payable to the Secretary of State, in the form of a check or money order. Do not send cur-
rency in the mail.
9. The Secretary of State will forward your commission to you (or to your surety company, if requested to
do so by enclosing a self- addressed return envelope with the application.)
10. Please tear off and keep these instructions.
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State Form 40889 (R7 1-03)
Approved by State Board of Accotaus ,1997 TODD ROMA
SECRETARY OF STATE
NOTARY PUBLIC APPLICATION*
Including:
Request to be appointed a Notary Public
Notarial Oath
Notarial Bond
Instructions
IC 33- I6 -2 -1: (as amended)
Sec. I (a) Any applicant for a commission as a notary public shall possess the following qualifications:
(1) be at least eighteen (18) years of age; and
(2) be a legal resident of the State of Indiana.
(b) A notary public shall be appointed and commissioned by the Governor. A notary public shall hold
office for eight (8) years. A notary public, when so qualified, shall be authorized to act within the State of Indiana. A person may
request an application to become a notary public from the Secretary of State. The application shall be prescribed by the Secretary of
State and shall include the applicant's county of residence, oath of office, and official bond. The application shall also contain any
additional information necessary for the efficient administration of this chapter. The applicant shall personally appear, with an
application, before an officer authorized by law to administer oaths who shall administer an oath of office to the applicant. The
applicant shall secure an official bond, with freehold or corporate security, to be approved by the Secretary of State in the sum of five
thousand dollars ($5,000). The official bond shall be conditioned upon the faithful performance and discharge of the duties of the
office of notary public, in all things according to law, for the use of any person injured by a breach of the condition. The completed
application shall be forwarded to the Secretary of State. The Secretary of State shall forward each commission issued by the Governor
to the applicant or the applicant's surety company.
Notary Department
Secretary of State's Office
Room 201 State House
Indianapolis, Indiana 46204
317- 232 -6542
This application should also be filled out by current notaries public desiring to extend their commission
for another term. There is no separate renewal form or procedure.
IT IS A CRIME TO PERFORM ANY OF THE DUTIES OF A NOTARY PUBLIC UNTIL COMMISSIONED BY THE
GOVERNOR, IT IS IMPORTANT THAT YOU POSSESS A CURRENT, VALID COMMISSION BEFORE ACTING AS A
NOTARY PUBLIC. THE FILING OF THIS APPLICATION OR THE TAILING OF THE OATH CONTAINED AS PART OF
THIS APPLICATION DOES NOT AUTHORIZE YOU TO ACT AS A NOTARY PUBLIC.
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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
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 ($5), payable to the Secretary of State, in the farm of a check or money order. (Do not send currency in
the mail.) (IC33- 16 -2 -1)
PRINT OR TYPE
1. NAME z W S 2�
Yourlegal srynature in which commis: ion wiz] be Issued see brstrva ion #3
2. HOME ADDRESS
Number and street
City a� ZIP code
3. COUNTY OF RESIDENCE
4. Business or Employer's Name
5. Business or Employer's Address C--w S O.uac�
Street (Sty state ZIP code
6. HOME PHONE y�� ao OFFICE PHONE
Ma Cade Number Area Code 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 on/
county in which oah� ministered
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 1 am duly
qualified to hold office under the Constitution and laws of the State; that I am 18 years ofage 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
ped ury).
r silmiure of applicam
Ptxe 0ft,cer. s: al Here Subscribed and sworn or affirmed to before me, this day of f�-i
A.D. 20 cg IN TE IMONY WHEREOF, I, d./ 6 �lv M G UrVI-CF-1
Print 1" ,ped name a,.McCr
a
D for the
Chif Tommission ure of ¢notarypub6c, rotherollieaauthoriadtoadmirwero shs p Ce
ti t ot\! State of Indiana.
OtG acs coon rygf residm¢
My expires: tiTuL-y IS
130TH: 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 as principal
Nano oCApplicant
(applicant) and of
Name of Surety
and Count as
Strc` oddnss,city, sae &ZlPcode ty
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 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 principal's commission to the expiration date of the same.
Signature ofappit<tmt. Must be xknowl cdgcd bdowin #I signature ornroty. Must be admowledgd below in 912
11. ACKNOWLEDGEMENT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY
LAW TO TAKE ACKNOWLEDGEMENTS.
STATE OF COUNTY OF R L o N
SS:
County to which admowkdg=ct it being 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
Primed ortypad nameofappEeatt
pur, oses th^,rain expressed, without condition or reservation.
P4c- Vricer's se.:! %ere IN TESTIMONY WHEREOF, I J) EA N, Q t-, fj w ep have hereunto set my
Pti ntd or typed name or officer
hand and cofficial seal, this day of 20 CIE)
Si mnn: p fauthorizd Orrxcr J o e
for th(e County of 1 I M Ar21 0t j State of �dt a-
t Of ficef s county ofresidence ,I
My commission expires: �J 0! k/
12. ACKNOWLEDGEMENT OF SURETY'S SIGNATURE (Freehold or Corporate) BY A NOTARY PUBLIC OR OTHER OFFICER
AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. (NOTE. The officer can not acknowledge his1her own signatrire)
STATE OF COUNTY OF
SS:
County in which admwiedgemeat is being 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
Printed ortypcd nameof individial signing as suary
purposes therein expressed, without condition or reservation.
Place Officer's seal here IN TESTIMONY WHEREOF, I have hereunto set my
Pdntd or typed name of officer
hand and official seal, this day of 20
,a
Signatu. orauthorved orr=r office
for the County of State of
Officers county erresidmce
My commission expires
13. SUPPORTING AFFIDAVIT TO BE USED IN SUPPORT OF A FREEHOLD SURETY.
STATE OF INDIANA, COUNTY OF SS:
County in which oekrowldgement is being rude
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.
Signature o(suray
Place Officcr's seal here IN TESTIMONY WHEREOF, I
have hereunto set my
Printed or typed nam a of olficc
hand and official seal, this day of 20
a
Signature of authorized officer office
for the County of State of
Officer's county of res i4mce
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 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
Q
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
IN SUM OF
�o .oa
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I 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
o�
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund