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Home My WebLink About162689 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 00351684 Page 1 of 1 ONE CIVIC SQUARE CLERK OF THE COURTS ANNUAL FEES CHECK AMOUNT: $230.00 ti CARMEL, INDIANA 46032 P 0 BOX 6069 DEPT 179 INDIANAPOLIS IN 46206 -6069 CHECK NUMBER: 162689 CHECK DATE: 8120/2008 DEPARTMENT AC COUN T PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION 1160 4355300 10131 -49 115.00 ORGANIZATION MEMBER 1160 4355300 19106 -49 115.00 ORGANIZATION MEMBER I i I I i First Notice 10131 -49 pR�usII�rgre CLVD65VW v, INDIANA SUPREME COURT Current Status: Active 115.00 2008/09 ATTORNEY yocccX ANNUAL REGISTRATION STATEMENT PAY ANNUAL ATTORNEY FEE FOR ACTIVE OR INACTIVE STATUS If your status is inactive, you MUST complete the Affidavit of Inactivity on the reverse side of this statement. You have a duty to provide current information to the Clerk. If either address listed below is no longer valid, then please make any necessary corrections here: MR DARRELL NORRIS 101 2ND AVENUE, S.W. #2C 101 2ND AVENUE, S.W. #2C CARMEL, IN 46032 -2027 CARMEL, IN 46032 -2027 r........ TOTAL AMOUNT DUE RETURN THIS STATEMENT WITH YOUR CHECK MADE PAYABLE TO: Postmark Date Active Status Inactive Status Address for annual fees mailed in Address for annual fees personally delivered Clerk of the Courts Annual Fees Clerk of the Courts Annual Fees 8/1-10/1 $115.00 57.50 P.O. Box 6069 Dept. 179 402 W. Washington St., Rm. W062 10/2 -10/15 180.00 107.50 Indianapolis, IN 46206 -6069 Indianapolis, IN 46204 10/16 -12131 $230.00 $157.50 OR PAY YOUR ANNUAL FEE AND UPDATE YOUR INFORMATION AFTER 12/31 $380.00 $157.50 ON THE CLERK OF COURTS WEBSITE! (See below) INSTRUCTIONS FOR COMPLETING YOUR ANNUAL FEE STATEMENT ONLINE: To pay your annual fee and /or change your contact information with the Roll of Attorneys online, go to http /courts.in.gov /cofc and click on the link to "Attorney Registration Online." IMPORTANT: A convenience fee of $3.50 plus 2% of your total attorney fee due (including any penalty for late payment) is charged by accesslndiana for payment by credit card. REOUIRED IOLTA CERTIFICATION Please check one of the following: I /my firm participate(s) in Indiana's IOLTA program. Compliance with Rule 1.15 was completed by creating and maintaining (an) interest bearing trustaccount(s) for qualified clients' funds. [Enrollment forms and IOLTA information are available at www.inbf.org, or call the Indiana Bar Foundation at 3177269- 2415.] D �7 IOLTA Account Number: o Attorney /Law Firm Name: /Y04CL_I' 197 VI -'iCl (5/ 1 4L NOTE: If you maintain multiple IOLTA accounts, please attach information on additional accounts to this form. I /my firm maintain(s) an IOLTA account in a state other than Indiana. am exempt from maintaining an IOLTA account because: El I am not in the private practice of law, or my practice does not involve Indiana client trust funds, or I do not have an office within the State of Indiana. I am a judge; an attorney employed by a local state, or federal government, on duty with the armed services; a corporate counsel; or a teacher of law; and I am not otherwise engaged in the private practice of law. Participation in the IOLTA program would work an undue hardship on me and /or would be extremely impractical based on the geographic distance between my principal'; office and the closest-depository institution participating in the IOLTA program and/or other compelling and necessitous factors. Please attach on a separate piece of paper an explanation of why you are seeking this undue hardship exemption. IMPORTANT! IF YOU DO NOT COMPLETE YOUR IOLTA CERTIFICATION, YOUR STATEMENTAND CHECK WILL BE RETURNED TO YOU, AND YOU MAY OWE A LATE FEE Please see reverse side. AFFIDAVIT OF INACTIVITY OR RETIREMENT I wish to place or retain my Indiana law license in inactive F I wish to place my Indiana law license into retired status. I am status. I am currently in either active or inactive good currently in either active or inactive good standing status. I standing status. I neither hold judicial office nor engage in neither hold judicial office nor engage in the practice of law the practice of law in Indiana. I understand that this status in Indiana. I am at least 65 years old. I acknowledge that this carries a reduced annual registration fee of 557.50. status, which carries no registration fee, exists for attorneys who do not plan to return to the practice of law. I i I swear or affirm under penalties of perjury that the foregoing statements regarding my inactivity or retirement status are true. Date: Signature: it ATTORNEY SURROGATE DESIGNATION If you engage in the private practice of law in Indiana and do not practice solely as an employee of a partnership, limited liability company (LLC professional corporation (PC), limited liability partnership (LLP), another lawyer, or an organization not engaged in the private practice of law, then pursuant to Admission and Discipline Rule 23 27(b)(1) you may designate a member in good standing of the Indiana Bar to act as your attorney surrogate should you become unable to practice law due to death, disappearance, disability, suspension, or disbarment. I hereby designate the following member in good standing of the Indiana bar to act as my attorney surrogate pursuant to Admission I, and Discipline Rule 23 27 (NOTE: Partners, shareholders, owners, and other non- employee lawyers practicing with one or more mem- bers of the Indiana Bar within partnerships, LLCs, PCs, or LLPs should designate their Fiduciary Entity rather thanes specific attorney -see i Admis. Disc. R. 23 27(b)(2)): I Surrogate I or Entity: Bar No.: Office: Home: IE 1i I� �I I Ic If 1 have listed a surrogate attorney above, then by signing below I certify that s /he has agreed to this designation in writing and that we both have copies of the agreement in our possessions. (NOTE: Designation invalid without this certification. I j Date: Signature: i i J f I OPTIONAL RACE /ETHNIC INFORMATION In an effort to obtain accurate information about diversity within Indiana's legal profession, the Indiana Supreme Court, through its Commission on Race and Gender Fairness, requests that attorneys fill out the following demographic information: GENDER: Male Female RACE: Caucasian African American American Indian /Native American Asian American Hispanic /Latino Other CONTACT US Clerk of the Su Court, Court of Appeals, For all IOLTA questions, please contact the Indiana Bar Foundation at 800 279 -8772 or and Tax Court 200 W. Washington St., Rm. 217 IOLTA@inbf.org. Indianapolis, IN 46204 -2795 For all questions about the Attorney Annual Fee Process, please contact the Roll of Attorneys PHO: 317- 232 -1930 Administrator at 317 -232 -5861 or rollatty@courts.state.in.us. FAX: 317- 232 -8365 clerk @courts.state.in.us Visit the Clerk's website at http: /courts.IN.gov /cok Prescribedby State Board of Accounts City Form No. 201 (Rev. 1995) :j ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 8/18/08 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 Clerk of the Courts Annual Fees Purchase Order No. -P. 0. Box 6069 Dept 179 Terms Indianapolis IN 46206 -6069 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/1/08 10131 -49 Indiana Supreme Court 2008/09 Attorney Annual $115.00 Registration Statement for Darrell Norris Total 115.0 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. 8 ALLOWED 20 7lerk of the Courts Annual Fees IN SUM OF P. 0. Box 6069 Dept 179 Indianapolis IN 46206 -6069 115.00 ON ACCOUNT OF APPROPRIATION FOR 1160 Mayors 4355300 Organization Membership Dues Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 10131 -49 4355300 $115.0 0 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 ig t re Cost distribution ledger classification if Title claim paid motor vehicle highway fund First Notice 19106 -49 T2WL07NX V cS.T,9 Jam... INDIANA SUPREME COURT o ee' Current Status: Active s 115.00 Cd ''A 2008 /09ATTORNEY ANNUAL REGISTRATION STATEMENT PAY ANNUAL ATTORNEY FEE FOR ACTIVE OR INACTIVE STATUS If your status is inactive, you MUST complete the Affidavit of Inactivity on the reverse side of this statement. You have a duty to provide current information to the Clerk. If either address listed below is no longer valid, then please make any necessary corrections here: MS NANCY HECK 1326 COOL CREEK DRIVE CITY OF CARMEL CARMEL, IN 46033 -2315 1 CIVIC SQUARE CARMEL, IN 46032 -0000 or y1wel TOTAL AMOUNT DUE RETURN THIS STATEMENT WITH YOUR CHECK MADE PAYABLE TO: Postmark Date Active Status Inactive Status Address for annual fees mailed in Address for annual fees personally delivered Clerk of the Courts Annual Fees Clerk of the Courts Annual Fees 8/ 1 15:00 57.50 P.O. Box 6069 Dept. 179 402 W. Washington St., Rm. W062 10/2-10/15 180.00 107.50 Indianapolis, IN 46206 -6069 Indianapolis, IN 46204 10/16-12/31 $230.00 $157.50 OR PAY YOUR ANNUAL FEE AND UPDATE YOUR INFORMATION AFTER 12/31 $380.00 $157.50 ON THE CLERK OF COURTS WEBSITE! (See below) INSTRUCTIONS FOR COMPLETING YOUR ANNUAL FEE STATEMENT ONLINE: To pay your annual fee and /or change your contact information with the Roll of Attorneys online, go to http /courts.in.gov /cofc and click on the link to "Attorney Registration Online." IMPORTANT: A convenience fee of $3.50 plus 2% of your total attorney fee due (including any penalty for late payment) is charged by accesslndiana for payment by credit card. REQUIRED IOLTA CERTIFICATION Please check one of the following: I/my firm participate(s) in Indiana's IOLTA program:, Compliance with Rule 1.15 was completed by creating and maintaining (an) interest- bearing trust account(s) for qualified clients' funds. [Enrollment forms and IOLTA information are available at www.inbf.org, or call the Indiana Bar Foundation at 31.7 -269- 2415.] Indiar.a.IOLTA_Aecol. nt-Financial.!nstitutior IOLTA Account Number: Attorney /Law Firm Name: NOTE: If you maintain multiple IOLTA accounts, please attach information on additional accounts to this form. I /my firm maintain(s) an IOLTA account in a state other than Indiana. I am exempt from maintaining an IOLTA account because: I am not in the private practice of law, or my practice does not involve Indiana client trust funds, or I do not have an office within the State of Indiana I am a judge; an attorney employed by a local, state, or federal government; on duty with the armed services; a corporate counsel; or a teacher of law; and I am not otherwise: engaged in the private practice of law. Participation in the IOLTA program would work an undue hardship on me and /or would be extremely impractical based on the geographic distance between my principal office and the closest depository institution participating in the IOLTA program and /or other compelling and necessitous factors. Please attach on a separate piece of paper an explanation of why you are seeking this undue hardship exemption. IMPORTAINT! IF YOU DO NOT COMPLETE YOUR IOLTA CERTIFICATION, YOUR STATEMENT AND CHECK WILL BE RETURNED TO YOU, AND YOU MAY OWE A LATE FEE *I Please see reverse side. i AFFIDAVIT OF INACTIVITY OR RETIREMENT I wish to place or retain my Indiana law license in inactive I wish to place my Indiana law license into retired status. I am status. I am currently in either active or inactive good currently in either active or inactive good standing status. I standing status. I neither hold judicial office nor engage in neither hold judicial office nor engage in the practice of law the practice of law in Indiana. I understand that this status in Indiana. I am at least 65 years old. I acknowledge that this carries a reduced annual registration fee of $57.50. status, which carries no registration fee, exists for attorneys who do not plan to return to the practice of law. I swear or affirm under penalties of perjury that the foregoing statements regarding my inactivity or retirement status are true. ii Date: Signature: ATTORNEY SURROGATE DESIGNATION If you engage in the private practice of law in Indiana and do not practice solely as an employee of a partnership;, limited liability company (LLC), professional corporation (PC), limited liability partnership (LLP), another lawyer, or an organization not engaged in the private practice of law, then pursuant to Admission and Discipline Rule 23 27(b)(1 you may designate a member in good standing of the Indiana Bar to act as your attorney surrogate should you become unable to practice law due to death, disappearance, disability, suspension, or disbarment. 1 hereby designate the following member in good standing of the Indiana bar to act as my attorney surrogate pursuant to Admission! and Discipline Rule 23 27 (NOTE: Partners, shareholders, owners, and other non employee lawyers practicing with one or more mem- bers of the Indiana Bar within partnerships, LLCs, PCs, or LLPs should designate their Fiduciary Entity rather than <a specific attorney —see 1� Admis. Disc. R. 23 27(b)(2)): Ei Surrogate I! or Entity: Bar No.: f� Office: Home: j li I Iii Il If I have listed a surrogate attorney above, then by signing below I certify that s /he has agreed to this designation in writing 4 and that we both have copies of the agreement in our possessions. (NOTE: Designation invalid without this certification. Date: Signature: 1! r OPTIONAL RACE /ETHNIC INFORMATION In an effort to obtain accurate information about diversity within Indiana's legal profession, the Indiana Supreme Court, through its Commission on Race and Gender Fairness, requests that attorneys fill out the following demographic information: GENDER: Male Nr Female RACE: Caucasian F African American El American Indian /Native American D Asian American Hispanic /Latino F� Other CONTACT US Clerk of the Su Court, Court of Appeals, For all IOLTA questions please contact the Indiana Bar foundation at 800- 279 -8772 or and Ta x, Court IOLTA @inbf.org. 200 W. Washington. St., Rm. 217 Indianapolis, IN 46204 -2795 For all questions about the Attorney Annual Fee Process, please contact the Roll of Attorneys PHO: 317- 232 -1930 Administrator at 317- 232 -5861 or rollatty @courts. state. in. us. FAX: 317 -232 -8365 clerk @courts.state.in.us Visit the Clerk's website at http /courts.IN.gov /cok. i Prescribedby State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 8/18/08 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 C lerk of the Courts Annual Fees Purchase Order No. P 0. Box 6069 Dept. 179 Terms I ndianapolis IN 46206 -6069 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/1/08 19106 -49 Indiana Supreme Court 2008/09 Attorney Annual $115.00 Re istration Statement for Nancy Heck Total $115.00 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 Clerk of the Courts Annual Fees IN SUM OF P. 0. Box 6069 Dept 179 Indianapolis IN 46206 -6069 115.00 ON ACCOUNT OF APPROPRIATION FOR 1160 Mayors 4355300 Organization Membership Dues Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 19106-49 4355300 $115,00 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 gnatu�_ Cost distribution ledger classification if Title claim paid motor vehicle highway fund