HomeMy WebLinkAbout162447 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 360386 Page 1 of 1
ONE CIVIC SQUARE NOTARY PUBLIC UNDERWRITERS INC
i. CARMEL, INDIANA 46032 PO BOX 1103 CHECK AMOUNT: $125.00
INDIANAPOLIS IN 46206 CHECK NUMBER: 162447
CHECK DATE: 8/7/2008
DEP ACCO P O NUMBER I N UMBER AMOUNT D ESCRIPTION
902 4239099 125..00 OTHER MISCELLANOUS
i
Indiana Notary Public Bond
10. NOTARIAL BOND
KNOW ALL BY THESE PRESENTS, that we M
r- r _u as principal cX
Name of Applicant pl:
(applicant) and UNIVERSAL SURETY OF AMERICA, of 950 Echo Lane, Suai #250, Houston, TX 77024, and Harris County as corporate
sure Y, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment ot
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 T14E 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
rom the effective date of the principal's commission to the expiration date of the same.
UNIVERSAL SURETY OF AMERICA CR
Bv
Jack Diestelhorst Attorney In Fact
Signature of Surety. Must be acknowledged below in #12
X (Y%, COUNTERSIGNATURE
Signature or appl Must be acknowledge in _#1 1
4 Frahn Rouse Indiana Resident Agent
11. ACKNOWLEDGMENT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OR OTHER
OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGMENTS-
County in which acknowledgment is being made
Before me the undersigned, an officer authorized to take the acknowledgment of deeds (Notary Public, County Clerk, etc.) personally
appearedSA e. �j S 14� and acknowledged the execution of the foregoing bond for the uses and
Pritted or typed name of applicant
purposes therein expressed, without condition or reservation.
Place Officer's Seal Here IN TESTIMONY WHEREOF, I have
Printed or typed name of officer
hereunto set my hand and official seal, this day of a"4L4*_, 20-a-—_
a for
Sigft
Officers county of residence
My commission expires:
12. ACKNOWLEDGMENT OF SURETY'S SIGNATURE (Corporate) BY A NOTARY PUBLIC OR
OTHER OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGMENTS. (NOTE: The officer
cannot acknowledge his1her own signature.)
STATE OF INDIANA, COUNTY OF MARION SS:
County in which acknowledgment is being made
Before me the undersigned, an officer authorized to take the acknowledgment of deeds (Notary Public, County Clerk, etc.) personally
appeared Jack Diestelhorst and acknowledged the execution of the foregoing bond for the uses and purposes therein expressed, without
condition or reservation.
Place Officer's Seal Here IN TESTIMONY WHEREOF, I David T. Rankin, have hereunto set my hand and official seal,
thi PPND
DAVID T. RANKIN day of O=RE8 20 07
Tippecanoe -1
No County
i "Air a NOTARY PUBLIC for the County
S�L My Commission Expires Signature of aut
of T_IP FCANC)F State of INDIANA.
Officers county of residence
My commission expires: 0=BER 4, 201 _5
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.
Do Not Write In This Box For Office Use Only Complete and Return to,,.
Commission hwDAUNK
UUDERWRITW, W.
Expiration Date of New Commission: P.O. Box 1103
Indianapolis, IN 46206 -1103
800.821.0828
APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STATE OF INDIANA
To: THE GOVERNOR OF INDIANA
I respectfidly 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 form of a check or money order. (Do not send currency in the mail.)
(IC 33- 16 -2 -1)
PRINT OR TYPE
C
1. NAME: e o� 1 i C� I k
Your legal signature in which commission will be issued see instructions
2. HOME ADDRESS: 3 (,a (P a E. C C�t _D r LQ e_
Number and Street
C arr rrn Z f\J 4 4
City State Zip Code
H
3. COUNTY OF RESIDENCE: amt r L n
4. Business or Employer's Name:
5. Business or Employer's Address: One C i i G JCS ulot_c C.Ct f la e- i T �J 1 4 ZO c 3 3
Street L S— OFFICE PHONE: City state Zip Code
6. HOME PHONE: 1) 4 9 r 7 H 3 I a 1 9 1
Area Code Number Area Code Number
7. If you have a current valid notary commission, show your expiration date:
8. If you are now a public and your name or county has changed since your last application, please give both old and new information.
N OLD: vl A
NEW: A(/ A
9. NOTARIAL OATH
STATE OF INDIANA
SS:
COUNTY OF
County in which oath 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.)
O ignature of Applicant
Place Officer's Seal Here Subscribed and sworn or affirmed to before me, this day of A.D.
20 IN TESTIMONY WHEREOF, I,
Printed or typed name of officer
,a
Signature of a notary public or other officer authorized to administer oaths Office
for the County of State of Indiana.
Officer's county of residence
My Commission Expires:
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.
IN -01 (10/07)
Order Form
a ututut.notaryindiann.coin
ORDER ONE OF THESE
1 u h t ic COMPLETE NOTARY P ACKAGES!
D D D R D1 HIM I D C. Premium Notary Package
8 Year $5,000 Notary Bond $50
State Filing Fees $5 $71
Self Inking Notary Stamp $16
(your choice of stamp case color!)
THE STATE HAS INFORMED US THAT Classic Notary Package
YOUR COMMISSION EXPIRES 11/05/2008. g year $5,000 Notary Bond $50
State Filing Fees $5 $78
Round Self- Inking Stamp $23
(grey stamp case only)
Itlttltll�tl{. ttt�lll�tllttlttlltlllt ,lllltttltl {ttllititttlll Deluxe Notary Package
T7 -20 000150539-76 8 Year $5,000 Notary Bond $50
SHERRY S. MIELKE State Filing Fees $5 125
3662 E CARMEL DR Notary Public Record Book $9
CARMEL, IN 46033 -4317 Self- Inking Notary Stamp $16
(your choice of stamp case color.)
$10,000 Errors Omissions Policy $45
Free Shipping with Deluxe Notary Package
f ERRORS &OMISSIONS POLICIES*
Premium Notary Package (choose stamp case color) I $71.00
Classic Notary Package $78.00
Deluxe Notary Package (choose stamp case color) $125.00
Notary Bond State Filing Fees $55.00
10,000 Errors Omissi Polic $45.001 t t t t i t t t I
25,000 Errors Omiss Policy $80.00
50,000 Errors &Omissio Policy $208.00 al
$100,000 Errors Omissions PolicY $416.00
(V) Choose your stamp case color:
If no stamp color is specified, you will receive grey.
Heavy Duty Round Self- Inking Stamp 1 $35.00
Notary Public Record Book i $9.00
Round Self- Inking Stamp $23.00
❑Blue 21
Self Inking Notary Stamp (choose stamp case color) $16.00 Z3 ❑Grey 22
Self- Inking Expiration Date Stamp (choose stantp case color) $12.00 O a o4�
Hand Held Embosser $21.00 ❑Red 20
Travel Stamp $22.00
See Reverse
Impression Inker $9.75 F Side for
❑Mint 24
Display Sign $8.50 Product
American Society of Notaries One Year Membership $39.00 1
Window Decal $2.50 1 ___7
OYellow 25 ,�eSGript10P1S.
Shipping Handling (free when ordering De luxe Notnny Package) $4.00
AMOUNT ilac 26
ENCLOSED
Payment: Check Money Order ET9 C El El 6= r+'! Mail my products to: El Home L�Business El Other Address:
Card No.: n r M P_ P1 P iJ AI M P rr\o ck C6m m l
Business Name tt �1
Expiration Date: Security Code: W �J I' L0 f. Ia /i SL t I
Street Address /PO Box
Signature: Chi rM t 1- f 0
For Credit Card Information Only City G State ZIP
S i e I ke P
Daytime Phone: Email Address (For Notary Law Updates Special Offers)
IN 707 (10 /07) Mail Application, Order Form and Payment to: Notary Public Underwriters, Inc. P.O. Box 1103 Indianapolis, IN 46206 -1103
Order These. N btary Public Supplies Now
0 Visit Our Web Site at www.noIaryindiana com
$35 Heavy Duty Round- Notary Public $9
Self inking Stamp Record Book
L High quality stamp designed for high volume Record the details of the notari-
usage and many years of service. Great for t al acts you perform with this record
i' notary and professional legal seals. book. It includes room for 244 entries
and complete "how to" instructions.
'f �P NAMf �N,
Round State
l rPa xa. zov i Approved
er.: Notary Stamp
NOTARY SDI 9 not actual size.
z r
r
Self Inking Stamp
Express yourself with one of our colorful self inking stamps! The I
Round Self- Prinry stamp from Trodat® is now available in seven exciting colors.
Inking Stamp $23 Get clear, crisp impressions without using a stamp pad. (Choose stamp
The Trodat® round self- case color on front.)
inking stamp has a new ergonomic
design, as well as a wider base. Notary Stamp Ex- -piratlon
Designed to produce an imprint equal State Approved Rectangular 16 Date Stamp
in size and format to a standard metal Notary Stamp -not actual size.
Must be used in conjunction with
embosser. The difference is you'll get a Hand Held Embosser not actual size
more readable imprint. g;:w' YOUR NAME HERE Y
Marion County Nota Public State of Indiana
noTeRV
N. eFU My Commission Expires My Commission Expires:
re
April 2e, 2014 April 28, 2014
Nand Meld Embosser $21 Travel Stamp
This portable This new compact stamp 22
1phand held metal embosser is perfect if you are always
leaves a raised impression on on the go. Its slim design makes
the paper. A leatherette car- it convenient for traveling, while still producing
ymg case is included. crisp, clear impressions. It is also as easy to use as it
is portable, making it a great addition to your regu-
lar notary stamp.
Display Sign $8 50
This professional 5" x 7" ry e
Im ression 75
p personalized notary sign
Inker may be displayed on your wall or desk. It is custom
Black Ink, for use with engraved with your name and is attractively finished
the hand held embosser. with gold raised lettering on a black background.
American Society of Notaries $2
One Year Membership $39 Window Decal
The oldest national non -profit association for Let everyone know you are a notary with
notaries public in the United States. Benefits include instant our 3" x 5" window decal. For easy visibil-
information, toll -free helpline, newsletters, membership cer- iry this vinyl decal has a black background
tificate and more. with gold lettering.
i fl S a in p s a n. d S e a l s!
Order Form
1.800.821.0828 o www.notaryindiana.com
ORDER ONE OF THESE
COMPLETE NOTARY PACKAGES!
U U D R l� R I 1 R S I II Premium Notary Package
8 Year $5,000 Notary Bond $50
State Filing Fees $5 71
The Stanip of Excellence Self- Inking Notary Stamp $16
(your choice of stamp true color!)
THE STATE HAS INFORMED US THAT Classic Notary Package
YOUR COMMISSION EXPIRES 11/05/2008.
8 Year $5,000 Notary Bond $50
State Filing Fees $5 $78
Round Self Inking Stamp $23
(grey stamp ease only)
I�I��Itll�lll�l�l�ll���lll�ll�l��ll�l�llll�llllll���ll�l�l�lll Deluxe Notary Package
T7 -20 000150539-76 8 Year $5,000 Notary Bond $50
SHERRY S. MIELKE State Filing Fees $5 $125
3662 E CARMEL DR Notary Public Record Book $9
CARMEL, IN 46033 -4317 Self Inking Notary Stamp $16
(your choice of suanp case color.)
$10,000 Errors Omissions Policy $45
Free Shipping with Deluxe Notary Package
ERRORS OMISSIONS POLICIES*
Premium Notary Package (choose stamp case color) 71.00 o o Q e e e
Classic Not try Package f $78.00 9-a M'M o
t
Deluxe Notary Package (choosesuunp case, color) $125 .00
Notary Bond State Filing Fees $55.00
Brix i� p�
10,000 Errors Omissions Policy $45.00 o ee �l eee
25,000 Errors Omissions Policy $80.00
50,000 Errors &Omissions Policy $208.00
$100,000 Errors Omissions PolicY $416.00
ADDITIONAL SUPPLIES (V) Choose your stamp case color:
Heavy Duty Round Self- Inking Stamp $35.00 Ij no stmnp color is specified, you twill receive grey.
Notary Public Record Book $9.00
❑Blue 21
Round Self- Inking Stamp $23.00
Self- Inking Notary Stamp (choose stamp case color) $16.00 3
2 ❑Grey 22
Self- Inking Expiration Date Stamp (choose stmnp case color) $12.00 I JINX o
Hand Held Embosser $21.00 ❑Red 20
See Reverse
Travel Stamp $22.001
Side for
Impression Inker I I $9.75 ❑Mint 24
Display Sign $8.50 I Product
American Society of Notaries One Year Membership $39.00 Descrip tions!
Window Decal $2.50 Yellow 25
Shipping &Handling (free uthen ordering Deluxe Notary I'aclmge) $4.00
Lilac 26
AMourrr 1
//��c�
ENCLOSED
Payment: Check El Money Order ❑EB E11 Mail my products to: Home (Business El Other Address:
Card No.: �ra r nn 0 l �l sLf r m I .0 k
Business Name
III Lo, (Vl a t rl SL Ju (It NO
Expiration Date: Security Code: Street Address Box 1 i 0 3 3
Si
Signature: C A r �j
City n State zip
For Credit Card Information Only J Ii I e I c arrne-(r
Day Phone: 1 l Qh v
YV Email Address (For Notary Law Updates &Special Offers)
IN (10/07) Mail Application, Order Form and Payment to: Notary Public Underwriters, Inc. P.O. Box 1103 e Indianapolis, IN 46206 -1103
®rder These Notary Public Supplies Now!
Or Visit Our Web Site at wtvw.notaryindiana.cont
$35 Heavy Duty Round Notary Public $9
l Self- inking Stamp Record Book
t High quality stamp designed for high volume Record the details of the notari-
usage and many years of service. Great for al acts you perform with this record
notary and professional legal seals. book. It includes room for 244 entries
i Y�uulnllul and complete "how to" instr
I z. a ��JPNAMEyF
SAO �MISSIONFX :9F''�� Round State
Approved
Notary Stamp-
t J NO SEPI not actual size.
,p tIC, STP�
/111111 IIIIIIY
1
Self Inking Stamp
Express yourself with one of our colorful self inking stamps! The j
Round Self Printy stamp from Trodat® is now available in seven exciting colors.
Inking Stamp
Get clear, crisp impressions without using a stamp pad. (Choose stamp
The Trodat® round self- case color on front.)
inking stamp has a new ergonomic i
design, as well as a wider base. Notary Stamp Expiration
Designed to produce an imprint equal State Approved Rectangular Date Stamp
in size and format to a standard metal Notary Stamp not actual size.
Must tx used in conjunction with
embosser. 'I he difference is you'll get a Fland 1 -geld Embosser not actual size.
more readable imprint. ;.e' YOUR NAME HERE Notar Public State of Indiana
Marion County Y
sew My Commission Expires My Commission Expires:
?oi i;" April 28, 2014 April 28, 2014
Hand Feld Embosser Travel Stamp
This portable,
This new compact stamp
hand held metal embosser is perfect if you are always
leaves a raised impression on 1 on the go. Its slim design makes
the paper. A leatherette car I it convenient for traveling, while still producing
tying case is inducted. crisp, clear impressions. It is also as easy to use as it
is portable, making it a great addition to your regu-
lar notary stamp.
Display Sign $8 41, 50
'Phis professional 5" x 7"
Impression 75 personalized notary sign
Inker me* may be displayed on your wall or desk. It is custom
Blade Ink, for use with engraved with your name and is attractively finished
the hand held embosser.• with gold raised lettering on a black background.
American Society of Notaries 50
One Year Membership $39 Window Decal
The oldest national non profit association for Let everyone know you are a notary with
notaries public in the United States. Benefits include instant our 3" x 5" window decal. For easy visibil-
information, toll -free helpline, newsletters, membership cer- ity this vinyl decal has a black background
tificate and more. with gold lettering.
Lifetime Guarantee on all Stamps and Seals!
NotaryD iv
UUD(RU R11(RS, IU(.
P.O. Box 1103
Indianapolis, IN 46206 -1103
800.821.0828
Your Notary Public Commission
Is Expiring Soon...
Dear Notary Public:
Did you know that renewing early prevents a lapse in your commission and does not shorten your
current notary term? Notary Public Underwriters will completely handle your renewal process and
mail your notary products to you. Plus, all of our stamps and seals come with a lifetime guarantee!
WE HAVE ENCLOSED A COMPLETE SET OF NOTARY PUBLIC
APPLICATION FORMS APPROVED BY THE INDIANA SECRETARY OF STATE.
Let Notary Public Underwriters assist you by providing you with these great products and services:
Full Line of Stamps and Seals with a Lifetime Guarantee
Errors Omissions Liability Policies
Online Notary Education Course (no test required)
Toll -Free Hotline
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Membership in the American Society of Notaries
And the Best Customer Service in the Industry!
To begin the renewal process, complete the enclosed forms following the instructions on the reverse
side. Feel free to call us with any questions, and we'll be happy to help you.
Sincerely,
V jack Diestelhorst
President
P.S. Visit us online at www.notaryindiana.com and sign -up to receive e-mail alerts on notary law updates,
application changes, and product specials!
S e e I n s t r u c t i o n s On B a c h
IN -23 (10/07) w w w. not a r y in d i an a. c o m
INSTRUCTIONS FOR COMPLETING RENEWAL DOCUMEN'T'S
STEP 1 APPLICATION
Fill in all blanks completely. If any item is not applicable to you, please indi-
cate that fact with the words "NOT APPLICABLE" or "NONE" or "N /A`.
Do Nm war. in This Bo. Fo, ollKe ure any caper. and Arne. m,
Commlarion e:
Type or print your name exactly as you will sign your name as a notary public. EaP anM Daln al Naw Gp mbebn: m 1 L 1
You may use initials for your first or middle names, but not both. For example: tea
APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STAT O F OF INDIANA
Jill Smith, Jill E. Smith, J. Elizabeth Smith, Jill Elizabeth Smith, but not J. E. Smith. T° "IF OIIYEILNOR"I'MIANA
This requirement is for identification purposes and is for your protection.
II Pxcrr oR ryn:
I. NAM. Jani[r Miller
Fill in your current expiration date. If your commission has expired, write 9381 uedrnorchardD
i. NOME AUORESS:
"N /A", DO NOT write in your old expiration date. India a alt Ind,a_na 46108
J. COUMYOP RESIUCNCE: Mahn w
If you are not changing your name or county of residence, write "N/A" on the n "i" 2005 N Mai 2�" 92 01
EPA Rd, /ndianap I na ndia 461 24
Employer, AEOP,: St
provided lines. HOME 3
PHONE 7 555 -1782 oraPHOnE L3 555 -5963
NOTARY OATH Aa8 aa11U m
In the presence of a Notary Public, sign at the RED (X) as you want your com-
mission to be issued. The notary public will sign, complete the information on ;mow Y1,1
the lines provided and affix his /her seal.
A. srATe OP INDI Marion SS:
OP
Please note: Before taldng the oath it is important to determine if you are qualified to be a notary m uwr m c Iwn,� ..cM aNaP °rw uwm e m�Cm� �d Asa °r m w l m
my werirmemmla orr ePwlml�wl... nr We sue: Aa lam la Y °r. dawn mP.l <klau+
public ma
tno.4N,e, IMI 1 M rreNlly mN JI o nice ca vi0 Ni, .ppli<mion, uW Ina I uill fulNvny .m imPnialy
a Indiana law states that it shall be an indispensable qualification for persons to hold any office dianaae Ue Jmk, °f NOTARY PUBLIC 11 M1y k mveP .um dr awW ku..t my eWll od bliey,nklpm N
Irc uMa fine puP or P+IwYJ
within the state of Indiana, either by election or appointment, that such persons shall never have _t Pvlum x
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) Par(wr„ a, nm mkl�m.n 3p a J une AD
p l Tonya__�
a 6a.apR„n
rev A'ouv P)bfi[ d
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 N y a P .1 10.1aT6
shall serve as a notary public, and his acceptance of any such office shall vacate his appointment famma� P e kla
NOTE: Tk E°I,J 1'vm uun• Wr10wlle n.cl dlk.•ppli.aim.muuM mulua was Se<mluy d.Sae. Tk.ppliaml
as such notary, but this provision shall not apply to any person holding any lucrative office or as �nm ado °.i•rin`°
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 affirmation to support the constitution of this state, and of the
United States, and also an oath of office. (Indiana Constitution, Article 15, Section 4)
Ina 41Il 1. 1�1. 11111. 1: STEP 2 NOTARY BOND
Indiana Notary Public Bond
10. h'OTANIAL BOND lanky Miller
1 NY ALL nr' TB PRA ATS. yam I Print your name here.
(ygliuml.rUU`lIVPASAL5UREIY OFAME111G,nf 9lh Em° We.Sui¢RSO.IIawo°.TX "11aN.uClim Cwmyumpnue
uva).mneHWhW>'M1amCrw°Ik SUe d lldi.e.,u lk pnW wmd FB£TNOIIaANO WI r.vc lfSMl). N. PYrnnl
.A rM may mk �,we nieJ auxlm.aa kin.r.ame, •rd �Gm ®Imwa.lmJYnYInn.P<,mu-
SS au,iNUa< +a•.Y°°'vhdpa kb.. llltl CONOfrIUN Op'MEABO \'E OIILIGATION IS AS Poll.ON'S,IONTi'. I
C,I wFniAFAS.We.Nexe nnuN pri>iPllw yglid(a.19°iame°I nY lk Cnnru. o flk Slue °I lrtliw •.vquy PUnls.inW
Sign at the RED (X) as you will sign your name as a notary public.
oe, 4 ee ..fie pi°ripJ ,ku mur w rdwwh rr+.°ml .m aianv <e se emi., d aie dli°e of Nwry Iedr, b .0 Iky+
.<r.�m °ae. warrk.k•r a, naafi <.mk.miw.da.meP;emr<m.een,nma w.mle l•1... lk lwl°t uu narau
r�wrmmr.r mmmin.PmWn mmw.,nmm v m, m.
Ikea wu OP AMFAICw
i I The notary public will acknowledge your signature and complete the infor-
X
nation on the lines provided in item #11.
X. /y M�Rn, t01)vr1.RMONAILEE
STEP 3 ORDER FORM
11. ACKNIIWLF.wsn';Nr OF APPLICANYS SIGNATURE BY A NOTARY PUfl,IC OR (YTIIEN .-f t package OFFICER AUTHORIZED BY LAW TO TAKE ACKN(M'I,n:Ix;h1ENTS.`� Sele a notary package whic contains a notary "seal” stamp that is required
TAreoP Indiana .muNrr oP Afanan .ss.
by law. Indicate your stamp case color where applicable. Select additional
J anke Make� I se supplies you wish to purchase and total your order.
pmpam Lei. r.pm W. •film. am,lw• a
Tanya (3,61
led Iu.Opu r.iSd "en Iv TF3TMONY N1ffiEOF.1
mna war°Ia r<I mr war;awi. �w, 3rd la .Ya08k`r STEP PAYMENT
A�'mary Pub
ar wmmeeon rm�m a+o
aalppla -i Indiana Mail the completed forms with a credit card number, check or money order
Pm� Ap 1Q 1 Q 1016 made payable to NOTARY PUBLIC UNDERWRITERS in the enclosed
I AC'KNON'I.EIK:MEhT OF SURKIT;S SWNATURE ICuryuralr) BY A NOTARY PUBLIC OR
m HER OFFICER A11THORI7ED BY 1-AW 11) TAKE AC KNOWI.EIWMENTS. (MITE: The d r. postage paid envelope.
w arknoe'kdgr hiclher own signaruny
SiAIE Ot'INDIANA.fOtIMYOP SENiI� .55.
mun,ipi°J..ndfun•uWnWnule. WeaWOwINNrPI dJUd,IA)nan .'.OI Caws C".l,ee.l P
.PaN Iat ulm.kdaal fine exnvum d Ik r—., bma ra ik u,e• .ra purpm• IM1OmI eapeum..IJrarl
P�.r °��Hre EHMDNY' In�)p.IN,aT.R� °.k.rkma� Im >k .ro °aew�. Thank you for choosing
wno 1 Hama a= d ocloeEH
=.7��m -ice w a,.flakfaaY Notary Public Underwriters.
r _TIPPEC�nnb .SWe dIND1ANA.
tl_OGTOBEH 9.3115
V III, IIIAI.I /I .1111111 /A Illy, 1.1 r. .1111. Ir Osnl -n.wk 1 ,If ur1 am III. .iii. 11711 (i'. 1^
Preseribed 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
�V o �0a'tj P�-, -h 1, T'i c Purchase Order No.
1
'So I b 3 Terms
�L. l mc i 1 s �N 4 (a Ao 03 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
N o 4 P4 C. lcr'
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 2�
'V r �(.c b�t c Gr wrJcr In c.
y Una IN SUM OF
P. o js 11
SncAic„ oItj Iry 'F6aoto I Io3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
g0 2 340.44 5.° 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
Lf 20 Zoo X
Sign t r
Cost distribution ledger classification if Ti e
claim paid motor vehicle highway fund