HomeMy WebLinkAbout155444 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360386 Page 1 of 1
2 ONE CIVIC SQUARE NOTARY PUBLIC UNDERWRITERS INC CHECK AMOUNT: $75.00
CARMEL, INDIANA 46032 PO BOX 1103
INDIANAPOLIS IN 46206 CHECK NUMBER: 155444
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4347500 NOTARY 75.00 GENERAL INSURANCE
MR
1.,8'oi0 8210828 �v w�w com
ORDER ONE OF TliESE
N otary hi fi j COMPLETE NOTARY P ACKAGES
U U D I R �1 R I T R S I U C, Premium Notary Package
8 Year $5,000 Notary Bond $50
State Filing Fees $5.
Self- Inking Notary Stamp $16
(your choice of stamp case color!)
THE STATE HAS INFORMED US THAT Classic Notar Pa c k a g e
YOUR COMMISSION EXPIRES 05/07/2008. g
8 Year $5,000 Notary Bond $50
State Filing Fees $5
Round Self- Inking Stamp $23 F
(grey stamp case only)
Ilittltll�llltt�Itlilttltllllt. .Itllllllll�llllll�lll�llllll�l Deluxe Notary Package
T4 -6 000104811-70 8 Year $5,000 Notary Bond $50
State Filing Fees $5
JEAN A. BELCHER Notary Public Record Book $9 125.
1745 W 136TH ST Self- Inking Notary Stamp $16
CARM EL, IN 46032 -9423 (your choice of stamp case color!)
$10,000 Errors Omissions Policy $45
Free Shipping with Deluxe Notary Package
'E IOMIISS'It D NS POLICIES"
Premium Notary Package (choose scamp case color) $71.00 I U� e e
Classic Notary Package $78.00
Deluxe Notary Package (choose stamp case color) $125.00 e 0
Notary Bond State Filing Fees $55.00 e e
0 0 e o e e e e
10,000 Errors Omissions Policy $45.00
25,000 Errors Omissions Policy $80.00
50,000 Errors Omissions Policy $208.00
$100,000 Errors Omissions PolicY $416.00
e Choose your stamp case color:
Heavy Duty Round Self- Inking Stamp $35.00
If no stamp color is specified, you will 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 r' W i ❑Grey 22
Self- Inking Expiration Date Stamp (choose stamp case color) $12.00 ��4� t
P
Hand Held Embosser $21.00 9 ❑Red 20 See Reverse
Travel Stamp $22.00
Impression Inker $9.75 w int 24 Side for
Display Sign $8.50 t
Product
American Society of Notaries One Year Membership $39.00 Descriptions!
Window Decal $2 ❑Yellow 25
Shipping Handling (free when ordering Deluxe Notary Package) $4.00
AMourrr ❑Lilac 26
ENCLOSED
Payment: Check Money Order EB M E1= Mail my products to: Home Ltd Business Other Address:
I I I I I I I d n'/ 0 CA 2,�
Card No.: sL Je�� P
Business
Name I
Expiration Date: u�� Security Code: 0 /UL V/ C sg
Street Address /PO Box
Signature: CA IAI L /6 3 Z
For Credit Card Information Only City State Zip
Daytime Phone: l eAn a b.— P/` VKh iv C rf m
EBrail Address (For Notary Law Updates Speck] Offers)
tN oy Mail Appltcatto 0rder�F,orm and~Payment to blic Under_nters 'Inc',`. PO. Box,1103 !:Indratiapo]is,'IN'. 46206 1103,. c. .1 •s
10 Ier These N� 5 a P u�bl °c� es Now!
*,O�r Urs`i ®ur��ti,�eb S,a•t�•e at•�.�tuww ,n`o,taryind com
$5 Heavy Duty Round Notary Public $9
Self inking Stamp Record Book
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
and complete "how to" instructions.
i oo� s2B x 9e` Round State
o`Qb za t Approved
Notary Stamp
tea' NOTARY SUM C not actual sim
c
Self Inking Stamp
Express yourself with one of our colorful self inking stamps! The
found Self Printy stamp from Trodat® is now available in seven exciting colors.
nking Stamp X23 Get dear, crisp impressions without using a stamp pad. (Choose stamp
he Trodat® round self- case color on front.)
eking stamp has a new ergonomic
esign, as well as a wider base. Notary Stamp Explratlon
)esigned to produce an imprint equal State Approved Rectangulaz� Date Stamp
size and format to a standard metal Notary Stamp not actual size.
Must be used in conjunction with
mbosser. The difference is you'll get a Hand Held Embosser not actual size-
note readable imprint. YOUR NAME HERE
Marion County Notary Public State of Indiana
My Commission Expires My Commission Expires:
eai„o3 April 28, 2014 April 28, 2014
-land Held Embosser $2;1 Travel Stamp
This portable, This new compact stamp
hand held metal embosser is perfect if you are always
leaves araised impression on on the go. Its slim design makes
J the paper. A leatherette car it convenient for traveling, while still producing
Tying 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 $g 50
..9
This professional 5" x 7 A
Impression 75
personalized notary sign
Inker may be displayed on your wall or desk. It is custom
31ack Ink, for use with engraved with your name and is attractively finished
he hand held embosser. with gold raised lettering on a black background.
American Society of Notaries 3 9 so
One Year Membership a s
4 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.
etime w Guaran, tee on all ;Stamp an d S.eals
x�-�as }•u e 4 fib i ti� t�'1;� ��rs� f s ��r +v?�•: try` Zt ;�z�,6,W�: 't
T
'.F
N' fl ICEff Val•l 2 M W309 YN 1•(1•QYNYNl•iYN M�' 61' �l'( 1'6l`(1'(D "!1'(�'AhQ9
A
Indiaaia Notary Public Bond
10. NOTARIAL BOND
KNOW ALL BY THESE PRESENTS, that we as principal
,e Name of Applic nt
;e (applicant) and UNIVERSAL SURETY OF AMERICA, of 950 Echo Lane, Suite #250, Houston, TX 77024, and Harris County as corporate d•
surety, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment of
a.;
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.
UNIVERSAL SURETY OF AMERICA 0
BY
`o Jack Diestelhorst Attorney In Fact
d Signature of Surety. Must be acknowledged below in #12 0'
e!
COUNTERSIGNATURE
0 Signature or applicant. ust be acknowledged below in #11
ea
;ate
s,
By:
io Frahn Rouse Indiana Resident Agent
11. ACKNOWLEDGMENT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OR OTHER
OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGMENTS.
STATE OF �-r xd no_ COUNTY OF 4—CILZ b "fie q'
SS: m,
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 ?��✓,ChQ� and acknowledged the execution of the foregoing bond for the uses and
Printed or typed name of applicant
purposes therein expressed, without condition or reservation.
Place Officer's Seal Here IN TESTIMONY WHEREOF, I r aC ifn o 14 404,t�n have
Printed or typed nama of officer
hereunto set my hand and official seal, this 4 day of e Y1LAOLC 20 OL
•,o l r le a tat for
Signature of au i ed officer Office
the County of Vyi t State of rIA-1
Officers county of resid e!
My commission expires: a o I C)
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 his /her own signature.)
STATE OF INDIANA, COUNTY OF _MARKM SS:
County in which acknowledgment is being made a.
Before me the undersigned, an officer authorized to take the acknowledgment of deeds (Notary Public, County Clerk, etc.) personally
appeared Jack 1iestelhorst and acknowledged the execution of the foregoing bond for the uses and purposes therein expressed, without
.m COAdition or reservation, o
ar.
Place Officer's Seal Here IN TESTIMONY WHEREOF, I David T. Rankin, have hereunto set my hand and official seal, Q
this 22ND day of _QC_T_DB 20_07
spy' DRUID T. RANKIN
KTAR;= Tippecanoe County
a NOTARY PUBLIC fur the Count
SEAL My Commission Expires Signature of authorized officer ty m,
October 4, 2015 of S IPR�E C2N OF State of INDIANA.
o
Officers county of residence
My commission expires: ?O15
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 S-4.
i
a). IPaD. h911�JQMd).. l�l�l➢ �ffJ )Q➢:19.:Q1.:�).:Q1:.11:9 9:1� ➢:�L:Q�:l1:�MD:�
Do Not Write In This Box For Office Use Only Complete and Return to:
Commission
111ID(RWRIT(K 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
1 respectfully request that 1 be appointed and commissioned a Notary Public. In support of my application, 1 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)
/n
PRINT OR TYPE
1. NAME: A 1� A B gLG e
Your legal signature In which commission will be issued see instructions
2. HOME ADDRESS: 1 7 L I
Number and Street
Cpl ,2M (s I N Fl 6,31?,
City 1 State Zip Code
3. COUNTY OF RESIDENCE: 4 A M l L TD/y
4. Business or Employer's Name: O 614
5. Business or Employer's Address: ONE' G� y�L cS Q /jV
Street 2 city State Zip Code
6. HOME PHONE: 3 e` r 7 3 O 3 X Go OFFICE PHONE: J) 7) -5 21 2 V 02 5
Area Code 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 f or county has changed since your last application, please give both old and new information.
OLD: N
NEW: LI
S. NOTARIAL LATH
STATE OF INDIAN.. 1
COUNTY OF Gt'mt SS:
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 cormmissioned by the Governor, according to the best of my skill and ability, so help me God
(or under the pains and penalties of perjury.)
X
Signature of App±lcarl
Place Officer's Seal Here Subscribed and sworn or affirmed to before me, this day of J A.D.
20_0-?—. IN TESTIMONY WHEREOF, I, V1Gi(' ,40
Printed or typed name off'-ar
a �C)�C
Signature of a notary public or other f a thorized to ad inister oaths Office
for the County of 1 State of Indiana.
Oft efs county f residence
My Commission Expires: a T 109
NOTE: The Bond Form, starting with #10 on the back of this application, must be completed before retailing to the Secretary of State. The applicant_
must sign again in #10.
IN -01 O W071
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
P
dP
7l
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accofdance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
�75.
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1701 Ndi� S 6 3 75 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
Signature
Cost distribution ledger classification if Title x
claim paid motor vehicle highway fund