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Home My WebLink About199872 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 00351564 Page 1 of 1 ONE CIVIC SQUARE GARY CARTER 4748 BISHOPSGATE DR CHECK AMOUNT: $15.00 CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK NUMBER: 199872 CHECK DATE: 8/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4358300 15.00 OTHER FEES LICENSES Bureau of Motor Vehicles �I��I��IIIII��IIIlII�II�IIIIII�III��IiIII�II�II�iIIII��I�� h� Customer Detailed Transaction Receipt g B.V State Form 51714 (4 -04) Branch: VEHICLE SERVICES REGISTRATIONS Date: 0711912.011 Time: 10:17 EDT Visit ID: 1 gg 68� 3 045620 CSR: LB Visit Customer: CITY OF CARMEL Transactions Trans ID Trans Tvne Trans Subtvae Amoun t 194575708 Title Initial Title Issuance New Title Fee Vehicle $15.00 Vehicle: 1 F9BD3922CS217953 2012 SUR 39L RV Lien Holder: None Customer: CITY OF CARMEL Purchase Date: 06/06/2011 $15.00 Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1 e. Bureau of Motor Vehicles Customer Registration Fees Detailed Receipt 1! State Form 51718 (4 -04) Branch: (VgEHIICLE SERVICES REGISTRATIONS Date: 07/19/2011 Time: 9:48 EDT 16 Visit ID: 045620 Tran ID: 194578539 Visit Customer: CITY OF CARMEL STARS Trans 07191180300025 Transaction Type: New Motor Vehicle Registration Registration License Type: MUNICIPAL OWNED PlatelPermitlRegistration Number: Vehicle Identification Number: 1 F9BD3922CS217953 Vehicle Year: 2012 Vehicle Make: SURREY Vehicle Model: 39LTB Registration Year Fee Type Subtotal Total 2010 NONE (NONE) 2010 $0.00 Total NONE (NONE) 2010: $0.00 Organ Donation $0.00 Total for 2010: 0.00 Transaction Total: 0.00 !"`hnrn�r• ur.nr r.rorll+ r�rrJ .rill annoar �c o lino item rh7rno nn# �c +nt�l tr�ncar +inn r•h�rnc Done 1 of 1 APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES State Form 205 (R716 -04) Approved by State Board of Account 1997 TO BE COMPLETED BY A POLICE OFFICER, BMV OFFICIAL OR BMV CERTIFIED DEALER SiGNEE IfWE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA- FOR OUT OF STATE TITLES I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLtOWING TION ENTERED ON THIS FORM IS CORRECT. IIWE UNDERSTAND VEHICLE AND FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS. THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE, IIWE AGREE TO INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY LIABILITY ARISING FROM THIS TRANSACTION, R MAKE MODEL TYPE DATE X X INSPECTOR'S PRINTED NAME TITLE CITY DATE: (INSP ECTOR'S SIGNATURE BAD E BRAN I{ R Thelaw requireslhal you apply for Certificate of Title within thirty -one days from the date of purchase of J motor vehicle There is it delinquent fee of $21.00 far failure to do so. Attach Certificate of Title assigned by seller. On eu- DEALER PLATE NO. domed Titles, liens must be released. Supporting documents surrendered with this application cannot be returned to the applF cant. state fee for applying for Title is$15.00. min accordance with Federal Code383. TITLE NUMBER BRANCH NO INVOICE NO BMV USE ONLY t 07191180300016 803 MV- GOVERNMENT- PREVIOUS TITLE 'SOC. SEC./FEDERAL I.D. NO APPLICANT'S NAME BMV USE ONLY D 2. CITY OF CARMEL 0 STREET ADDRESS CITY STATE ZIP CODE N 8. 3 CIVIC SQ CARMEL IN 46032 -2584 0 T VEHICLE I.D. NUMBER VEH. YEAR VEH. MAKE VEH. MODEL NO. VEH. TYPE ODOMETER EXEMPT 4. 1 F9BD3922CS217953 2012 SUR 39L RV 0 M T FORMER TITLE NUMBER PURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y 5 OH 06/06/2011 5 No No Yes E FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS 6. CITY OF CARMEL 1 CIVIC SQ N CITY STATE. ZIP CODE BMV USE ONLY 7. CARMEL IN 46032 -2584 T H SECOND LIEN'S NAME STREET ADDRESS 8. S CITY STATE ZIP CODE LICENSE NUMBER LICE FORMS BMV USE ONLY A 9, USED LB R E GROSS RETAIL USE TAX AFFIDAVIT -I/NE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW A SELLING PRICE LE55 TRADE -IN /DISCOUNT AMOUNT SUBJECT TO TA AMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPT O 0.00 0.00 0.00 0.00 X PLACE 1 ARA.# Your Social Security numberl Federal I.D. number is being requested by this agency under IC4- 1-6 1. Disclosure is mandatory and this document cannot be processed without it. APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES 11111111111111 IIIIIEI11111111111111111111111111111111111111 2 0 5 1 9 4 5 7 5 7 0 8 CUSTOMER COPY Bureau of Motor Vehicles IIEIIIIIIIlVIIIIIIIIIIIEIIIIiIIIIIflllliilllllll Customer Transaction Receipt State Form 51717 (4 -04) r Branch: VEHICLE SERVICES REGISTRATIONS Date: 7/19111 Time: 10:17:30 am EDT Visit ID: 'f68645620 Your Visit Time Today: Visit Customer: CITY OF CARMEL Transaction Time 00:28:44 Total time Hrs.Min.Sec 00:28:44 Transactions Trans I Trans Typ Trans Subtype Amou 194575708 Title Initial Title Issuance New $15.00 194578539 Registration New Motor Vehicle Registration New $0.00 Subtotal: $15.00 Sales /Use Tax: $0.00 Total: $15.00 Payment Method Amount DL Number Authorization Number Name CREDIT $15.00 01783E Total Due: $15.00 Amount Paid: $15.00 Change Due: $0.00 Please help us improve our service by completing a one minute customer satisfaction survey. Your responses are completely confidential. Visit http: /www.in.gov /bmvsurvey /start and enter the survey code 168045620 to get started. Thank you If you have questions or comments, please call our Customer Service Center at 888 -myBMV -411. Page 1 of 1 11 11111111111111 1 111 11 11111111 1111 11111111111111111 i III I 111111 5 1 7 1 7 1 9 4 5 7 8 5 3 9 VOUCHER NO. WARRANT NO. Gary Carter ALLOWED 20 IN SUM OF $15.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 I I 43- 583.00 I $15.00 1 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 u� V d ,71 1 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 bill(s)) Plates for Safety Trailer $15.00 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 1 20 Clerk- Treasurer