157106 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: 146900 Page I of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL MGT
e CARMEL, INDIANA 46032 CASHIER'S OFFICE -MAIL CODE 50 -10C CHECK AMOUNT: $100.00
100 N SENATE AVE CHECK NUMBER: 157106
n" INDIANAPOLIS IN 46207 -7060
CHECK DATE: 3!512008
-r
L)f= PARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION
1125 4340000 84441 100.00 RECORDING FEES
It,
INVOICE
Please Remit To: Page: 1
INDIANA DEPT OF ENVIRONMENTAL MGMT Invoice No: 000084441
r CASHIER OFFICE MAIL CODE 50 -10C Invoice Date: 01/02/2008
100 NORTH SENATE AVENUE Customer Number: CST100010357
INDIANAPOLIS IN 46204 F TRZ�C�A �VE Bill Type: 062
Payment Terms: NET 60
FEB 1 1 2008 Due Date: 03/02/2008
Bill To:yy�p
eff T t F C*L
ELLLL BY' p AMOUNT DUE: 100.00 USD
34
/A�(I S Amount Remitted
x Note Address Changes Above O03°
For billing uestions, please call 317 233 -0604
Line Ad' Identifier Description Quantity UOM Unit Amt Net Amount
PLEASE NOTE NEW REMIT TO ADDRESS ABOVE.
This annual fee billing is required for active Public water Systems (to defray the costs of
administering activities of the federal, Safe Drinking Water Act) under Indiana Code: IC 13 -18 -20.5.
To view via the internet, visit:
http: /www.IN.gov/ legislative /ic /code /titlel3 /arlB /ch2Q.5.html
Fees are based on the activity status as of December 31 of the previous year-
Fees on Transient Non- Community Water System will be based on the type of water system on record
by December 31 of the prior year.
Fees are not pro- rated. If a system is sold or inactivated during the billing year, the amount of
the assessed fee remains due and payable-
If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within. forty -five (45) days of this invoice date to pay in four
equal installments within a year.
Payments not received or received after the DUE date are subject to a delinquency charge equal to
10e of the assessed fee.
If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
For questions regarding your assessed fee amount, please contact the Drinking Water Branch, Office
of Water Quality at 317/306 -3282.
ATTENTION: The due date shown in the upper right hand corner of this invoice reflects the
standard 60 days past the invoice print date.
�1 06- IN2290801T -0 PWS Fee GW 1.00 100.00 100.00
TOTAL AMOUNT DUE 100.00
A copy of your invoice must be included with payment.
495 -IDEM Printed on Recycled Paper Original
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMFL
An invoice of 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.
IN Dept. of Environmental Mgmt.
Cashier Office -Mail Code 50 -10C Date Due
100 N. Senate Ave.
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
112/08 84441 Annual permit fee 100.00
Total 100.00
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.
IN Dept. of Environmental Mgmt. Allowed 20
Cashier Office -Mail Code 50 -10C
100 N. Senate Ave.
Indianapolis, IN 46204 In Sum of
100.00
ON ACCOUNT OF APPROPRIATION FOR
104- Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 84441 4340600 100.00 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
29 -Feb 2008
Signature
100.00 Amt Director
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund