163062 08/21/2008 1
CITY OF CARMEL, INDIANA VENDOR: 00350498 Page 1 of 1
ONE CIVIC SQUARE INDIANA NEWSPAPERS, INC
l CARMEL, INDIANA 46032 307 N_ PENNSYLVANIA STREET CHECK AMOUNT: $183.32
PO Box 145 CHECK NUMBER: 163062
INDIANAPOLIS IN 46206 -0145
CHECK DATE: 8121/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4345500 95.74 PUBLICATION OF LEGAL
206 4350900 87.58 OTHER CONT SERVICES
i
Form Prescribed by State Board of Accounts 900549 5279707 General Form No. 99 P (Rev. 1987)
t.
i
CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS
307 N PENNSYLVANIA ST PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145
PUBLISHER'S CLAIM.
LINE COUNT
Display Matter (Must not exceed two actual lines, neither of which
shall total more than four solid lines of the type in which the body
of the advertisement is set). Number of equivalent lines
Head Number of lines
Body Number of lines
Tail Number of lines
Total number of lines in notice
COMPUTATION OF CHARGES c�
89.0 lines 2.0 Columns wide equals 178.0 equivalent S 87.58
lines at .492 cents per line
Charges for extra proofs of publication (S 1.00 for each proof in excess of two) S .00 00
TOTAL AMOUNT OF CLAIM S
DATA FOR COMPUTING COST
Width of single column 7.83 ems Size of type 57 point S
Number of insertions 1.0 S 87.58
Pursuant to the provisions and penalties of Chapter 155, Acts of 1953,
1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
DATE: 08/08/2008 Clerk
Title
900549- 5279707 PUBLISHER'S AFFIDAVIT
PUBLIC NOTICES PUBLIC,F OC,ICE SI State of Indiana SS:
NQntrroelonERS Hamilton County
City of Carmel, Indiana
j Notice is hereh ry given that the Board of Public Works and
recetve sealed bids Cae l,OHSmilton County, n SW D2iil I Personally appeared before me, a notary public in and for said county and state,
age and Street tmerovements Project" at the office of the
Clerk Treasurer, ne Civic Square, Carmel, Indiana (City
undersigned Hail) until 10:00 am. Local Time on or before August R. the ndersi d Karen Mullins who, being du] s that SHE is clerk
2og90, and commencing as soon as practicable thereafter I g g Y sworn, says
during a special Board of Public. works Meeting on the same
date, such bids will be publiclyy opened and read aloud in the
Co. I Chambers ofQtyHalI .No late bids wiilbe accepted. Of the Noblesvill Led of a neWS a er of eneral circulation
All bids and proposals shall he properly and completely exe- p p
cuted on the. proposal forms provided with the plans and
specifications, which will include the non collusion affidavit
e s ealedan�havethewords "BIDTProect #08 06" -Ist printed and published in the English language in the city of NOBLESVILLE in state
Avenue SW Drains a and Street Improvements Project".
I A bid bond or cern ed check in an amount not less than ten
percent (lo o€ the amount hid must be submitted with
each bid. A one hundred percent (100%) perf ormance and I and county aforesaid, and that the printed matter attached hereto is a true copy,
ppaymentband will also be required of the successful bidder.
It is intended that actual construction of all work divisions
shall be started as soon as practicable, and eaohbidder
shall he prepared to eMerprompkly into a costruction which was dui p ublished in said paper for 2 time (s contract furnish a performance band, an d begin n
work with- Y p p p O, beCWee❑ the dates Of:
out delay in the event the award is made to him.
The Protect consists of, but is rat necessarily limded to.' the
following: 08/01/2008 and 08/08/2008
The' ost uction of Ist Avenue Sw beginningg on the north
side Ofdrd Street SW and proceeding north to the south side
of ist Street SW. The proposed improvements include new
I asphalt pavement, concrete curb and gutter, concrete side-
walk, curb mm s, storm sewers tem, future electric con
duiL street III �iting, mulch see dm ,and pavement mark-
ings. On- stre barking is proposed along the east side of Clerk
r 1st Avenue SW for the entire length of the project.
Contract Documents for the Project have been assembled Title
into one bound project manual, which together with draw
inggs, may be examined at the fallowing locations:
CityotC
entof Engineering -1st floor i Subscribed and sworn to before me on 08/08/2008
Department
One Civic Square
Carmel, IN 46032
CrossRoad Engineers, PC
3417 Sherman Drive
Beech Grove IN 46107
Beec 760-1545 N-%' i✓ a
I Attn: Trent E Newport, P.E., L5.
ob.
Copies of such drawnggs and project manuals must be
I tamed from CrossROad En meers at the address stated Notary Public
above, upon the paymentof for each set These sets in-
elude full -size drawings. Pay must he by check. ND —o
CASH ACCEPTEQ. Make checks payable to CrossRoad Engi• DENISE HAMBRITE
nears, PC. All paymentr and costs of contract Documen s
Form 65- sets My
arenon• refundable. NOTARY PUBLIC
Bidders shall assure that they have obtained complete
of drawings and Contract Documents and shall assume the SEAL
on incomp e m errors or om'iss'ions in bids urepared in relia
on lete sets o€ drawings and Contract Documents. nce STATE OF INDIANA
This Pr o w be funded b MY COMMISSION EXPIRES February 28, 2016
Wage rates for the Project shall not be less than the current ua Y
prescribed scale of wages as determined by the Common 1
Construction Wage Committee in accordance with I.C. 5 -16-
7 and included in the Project Manual.
A pre4cl conference for discussions of the Project the bid-
ding requirements and other important matters will be held I
on Wednesday August 13 at 10:00 AM Local Time in the Cau•
cus Room on t}le 2nd Floor of City Hall (One Civic Square).
All Prospective bidders are invited to attend the pre -bid
conference. The pre-bid conference is not mandatory.
For special accommodations needed by handicapped indi-
viduals planning to attend the Dre -bid conference or public i
bid opening meeting, please call or notify the city of, Carmel,
Engineer'sOffice at (317) 571 2447 at least tarty eight (48) 3
hours riortherelo.
No bidder may withdraw any hid or Vroposal within a period
of thirty (30) days following the date set for receiving bids
or proposals. The Carmel Board of Public Works and Safety
reserves the right to hold any or all bids or proposals for a I
period of not more than thirty (30) daq and said bids or
Pro shall remain in full force and erect during Bald
rind. The City of Carmel reserves the right to reject an
M�.anvand all bids, solicitations and /or offers m whole
Lcitatrons when d is not in
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
P.O. Box 145
Indianapolis, IN 46206 -0145
$87.58
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I:hereby certify that the attached invoice(s), or
SYS #13117 bills) is (are) true and correct and that the
5279707 materials or services itemized thereon for
which charge is made were ordered and
received except
8�� Y 20 0JF
Sig re
Cost distribution ledger classification if
Title
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
Indianapolis Newspapers, Inc.
Purchase Order No.
P.O. Box 145
Terms
Indianapolis, IN 46206 -0145
Date Due
Invoice Invoice Description Amount
Date Nu (or note attached invoice(s) or bill(s))
Acc t
8/8/08 SYS #13117 Legal Ad for Bidders 5279707
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
Forfn Prescribed by State Board of Accounts 900549- 5275022 General Form No. 99 P (Rev. 1987)
r
CITY` OF CAR EL- TOPICS LEGALS To: INDIANA NEWSPAPERS
307 N PENNSYLVANIA ST PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145
PUBLISHER'S CLAIM
t
LINE COUNT
Display Matter (Must not exceed two actual lines, neither of which
shall total more than four solid lines of the type in which the body
of the advertisement is set). Number of equivalent lines
Head Number of lines
Body Number of lines
Tail Number of lines
Total number of lines in notice
COMPUTATION OF CHARGES
74.0 lines 1.0 columns wide equals 74.0 equivalent S 24.35
lines at .329 cents per line
Charges for extra proofs of publication ($1.00 for each proof in excess of two) S .00 S -00
TOTAL AMOUNT OF CLAIM
DATA FOR COMPUTING COST
Width of single column 7.83 ems Size of type 5_7 point S
Number of insertions 1.0 S 24.35
Pursuant to the provisions and penalties of Chapter 155, Acts of 1953,
I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
DATE: 08/01/2008 Clerk
Title
900549- 5275022 PUBLISHER'S AFFIDAVIT
State of Indiana SS:
PUBLIC NOTICES Hamilton County
I PUBLIC NOTICE
PARTIES I REGARDING Personally appeared before me, a notary public in and for said county and state,
j PUBLIC HEARING TO BE
CONDUCTED BY THE
�AWORKSANDSAFETYLlc i the undersigned Karen Mullins who, being duly sworn, says that SHE is clerk
At the August 2008
meeting of the Boa d 0f
Public t works and Safety of
(thee City Board 1I of the Noblesville Ledger a newspaper of general circulation
I will hold a public hearing
beginning at 10:00 am.'M
the Council Chambers, Clty printed and published in the English language in the city of NOBLESVILLE in state
s Hall. 0 e civic square, Car-
Mel, Indiana, in order to: (D
receive public input on the
real °fpro po rty curren and county aforesaid, and that the printed matter attached hereto is a true copy,
owned by the City of Car
Mel and consisting of that
I real gpr opety beeng part of
,Tax Parcel Y lr0.17•�3- 11.02- which was duly published in said paper for 1 time(s), between the dates of:
01-016.001,'a portion of LOts
12 and M 15 in Penn -view
Heights Carmel, Indiana,
Heights plat thereof re- 08/01/2008 and 08/01/2008
corded In need Record 139,
PtO, County Recorde Of-
fice, which property is lo-
catedat 10407. and. 10409
Pennsylvania street in car- Clerk
mel, Indiana, less the right
of way for the expansion of
Pennsylvania street, as Title
more particularly described
below; (ii) allow interested
j E a i opportu to Subscribed and sworn to before me on 08/ &/1008
Oe heard regarding this
matter; (illyr allow the Board
to gather the Information it
deems necessary in order
f to he able to issue a recom-
mendation to the Mayor of
Carmel regarding the sale
of said property, and (IV) r6
r
conduct orwrel LOUISE M. POWELL NOtar Public
ilatedto the above. NOTARY PUBLIC
The legal description of
said ropertyis: SEAL
Form 65 -REV t -88 Lot Number 12 and 15 feet
by parallel lines off the My commission expires: STATE OF INDIANA
south side of Lot Numbered 20i 6
11 and 16 feet toy parallel
lines off the Nort h side of
Lot Number 13 in Penn•
view Heights, First section,
an addition in Hamilton
County. Indiana, asper plat Deed
R cord `139 pages 1 355 356
in the Office of the Re-
corder of Hamilton County
Indiana. Excepting, Twenty
five (25) feet, taken by par-
allel lines, off the entire
west side of the described
property.
Diana L Cordray
Clerk Treasurer
'r (NL• 9/01tOB- 5275022)
Form Prescribed by State Board of Accolmts 900549- 552749655 General Form No. 99 P (Rev. 1987)
n
CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS
307 N PENNSYLVANIA ST PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145
PUBLISHER'S CLAIM
LAVE, COUNT
Display Matter (Must not exceed two actual lines, neither of which
shall total more than four solid lines of the type in which the body
of the advertisement is set). Number of equivalent lines
Head Number of lines
Body Number of lines
Tail Number of lines
Total number of lines in notice
COMPUTATION OF CHARGES
82.0 lines 1.0 columns wide equals 82.0 equivalent S 26.98
lines at .329 cents per line
Charges for extra proofs of publication (S 1.00 for each proof in excess of two) .00 S .00
TOTAL AMOUNT OF CLAIM
DATA FOR COMPUTING COST
Width of single column 7.83 ems Size of type 5_7 point S
Number of insertions 1.0 S 26.98
Pursuant to the prohi.sions and penalties of Chapter 155, Acts of 1953,
1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
DATE: 08/01/200 Clerk
Title
900549- 5274965 PUBLISHER'S AFFIDAVIT
i PUBLIC NOTICES State of Indiana SS:
TO PUBLIC NfmCE Hamilton County
PARTIES REGARDING
PUBLIC HEARING TO BE
cR ONDUCTED OF PUBLIC Personally appeared before me, a notary public in and for said county and state,
WORKS AND SAFETY
At the August 20, 2008.
Public VvorRsand saf of the undersigned Karen Mullins who, being duly sworn, says that SHE is clerk
the Ci%fyof Carmel, Indiana
(the "9card the Board
will hold a public hearing of the Noblesville Led er a newspaper of eneral circulation
beginning at 10:00 a.m, in. g g
the Council Chambers, City
Hall, One Civic Square Car
m ana,in o:(
receive ceive public input put o on th e printed and published in the English language in the city of NOBLESVILLE in state
sale of a portion.of
I real property .currently
i owned-by the City of Car-
mel and consisting of that and county aforesaid, and that the printed matter attached hereto Is a true copy,
'real property being part of
Tax Parcel o. 17.13- 11 -02-
1 13 in Penn-view Heghts which was duly published in said paper for 1 time(s), between the dates of
Carmel Indiana; as per plat.
thereon recorded In Deed
Record ami DD my 6
R 08101./2008 and 08 /01 /2008
in the 139anes Ron County Re
corder's Office, which prop
erty located at 1 right Cr w�
Pennsylvania Street in Car
'.mel, Indiana, less the right'
of way for the expansion of Clerk
Pennsylvania street, as
more particularly described Title
below; (ii) allow interested
persons an opportunity to-
e heard regarding this
matter; (iii) allow the Board
.to gather th information it! Subscribed and sworn to before me on 08/01 008
deems necessary in order
'to be able to issue a recom-
mendation to the Mayor of
Carmel regarding the saie
of said Propertrtyy and' (iv) I
conduct any of her lawful
business connected or re-
Th edto the aescri LOUISE M. POWEL Notar Public
The legal dgscription' of
sa
O umber NOTARY PUBLIC
Lot Number 13 Penn- SEAL
View Heights, First t Section
an. addition in Hamilton,
Form 65 -REV t -88 thereof,, India d.Po My commission expires: STATE OF INDIANA
,Record 139 21316
in the Oftiice of Re
corder of Hamilton Countyy
Indiana and the North Haft'
of vacated 104th Street, be
in ng 25 feet in width by par-
allel.lines with the South
line of Said Lot Number 13,
recorded November 16,
1965 in Miscellaneous
I
Record 87. Page 100 in the
;Office of the Recorder of-
said County. EXCEPT 10
feet by parallel lines off the
entire North sid of Lot
Number 13 -in fyenn -View
Heights:
Also Excepting, Twenty-five
(25) feet taken by parallel
lines, off the entire west
side of the described prop.
erty,
Diana L Cordmy
Clerk- Treasurer
(NIL 8/01/39 5274965)
Form Prescribed by State Board of Acc%ints 900549- 5285972 General Form No. 99 P (Rev. 1987)
CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS
307 N PENNSYLVANIA ST PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, TN 46206 -0145
PUBLISHER'S CLAIM
LINE COUNT
Display Matter (Must not exceed two actual lines, neither of which S
shall total more than four solid lines of the type in which the body
of the advertisement is set). Number of equivalent lines
Head Number of lines
Body Number of lines S
Tail Number of lines
Total number of lines in notice
COMPUTATION OF CHARGES
69.0 lines 1.0 columns wide equals 69.0 equivalent 22.70
lines at .329 cents per line
Charges for extra proofs of publication (S 1.00 for each proof in excess of two) .00 S 00
TOTAL AMOUNT OF CLAIM
DATA FOR COMPUTING COST
Width of single column 7.83 ems Size of type 5_7 point S S
Number of insertions 1.0 S 22.70
Pursuant to the provisions and penalties of Chapter 155, Acts of 1953,
1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
DATE: 08/08/2008 Clerk
Title
900549 5285972 PUBLISHER'S AFFIDAVIT
State of Indiana SS:
Hamilton County
PU8LIt NOTfceoF Personally appeared before me, a notary public in and for said county and state,
ADOPnON OF RESOIUIION
I. CC 08- 18.08-01
Notice thi i hereb the undersigned Karen Mullins who, being duly sworn, says that SHE is clerk
of the City of Carmel, Indi-
ado p C-08-
4- B-01 approving a ten- of the Noblesville Ledger a newspaper of general circulation
year .personal property
and real propperr[t tax
GroupCompanes, Inc. far printed and published in the English language in the city of NOBLESVILLE in state
its investment in the in-
stallation of new qualify- I
ing information technol-
ogy(telecommunications• and county aforesaid, and that the printed matter attached hereto is a true copy,
egwyment and computer
hardware plus a partial
abatement of real pro
erty taxes attributable toil which was duly published in said paper for 1 time(s), between the dates of:
improvements made to;
i real estate. This Resolu-
tion, which affects the tol
I lowing described property 08/08/2008 and 08/08/2008
located in the City of Car- I
lmel, Indiana; NE Corner of
Carmel Drive %126tb'street I
and North Meridian
Street, Clay Township,
Hamilton County as de-
scribed in Exhibit A of erk
Resolution CC- 08- 04 -08 -01
the Property was Title
adopted following the fil-
1 ing of information by The
Capital GroupCompanies, Subscribed and sworn to before me on 08/08/2008
Inc. as an Economic Revi-
talization Area for the pur-
pose of securing a ten
year personal property
and real property. tax
abatement pursuant to to-
diana Code Section 6.1.1. 1
12.1 -4.
On the l8th of August l Notary Public
2008 at 6 p.m. in the Coun-
cil Chamber Room, lo-
cated at one Civic 5 uare,
Carmel, Indiana DENISE HAMBRITE
Form 65 -REV 1 -88 the common council will
j receive all remonstrance's My commission expires: NOTARY PUBLIC
and objections from inter-
ested persons regarding t
these proceedings. A de- STATE OF INDIANA
scription of the pro MY COM1 ISSION EXPIRES February 28, 201(3
and a copsg of Resolution
CC- 08- 04 -08 -01 are avail
able for inspection_ in the
Hamilton County Asses-
sor's Office Suite 214 33
North 9th S Nobles-
Ville, Indiana 46090.
For additional information
on the project, contact'
Larry Gigertch, Managing
Director, Ginovus 317 -819 1
0 8 /8/08 5285972) l
Form Prgcribed by State Board of Accirunts 900549- 5285969 General Form No. 99 P (Rev. 1987)
CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS
307 N PENNSYLVANIA ST PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145
PUBLISHER'S CLAIM
LINE COUNT
Display Matter (Must not exceed two actual lines, neither of which
shall total more than four solid lines of the type in which the body
of the advertisement is set). Number of equivalent lines
Head Number of lines
Body Number of lines
Tail Number of lines
Total number of lines in notice
COMPUTATION OF CHARGES
66.0 lines 1.0 columns wide equals 66.0 equivalent 21.71
lines at .329 cents per line
Charges for extra proofs of publication ($1.00 for each proof in excess of two) 00 .00
TOTAL AMOUNT OF CLAIM
DATA FOR COMPUTING COST
Width of single column 7.83 ems Size of type 5_7 point
Number of insertions 1.0 21,71
Pursuant to the provisions and penalties of Chapter 155, Acts of 1953,
1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after
allowing all just credits, and that no part of the same has been paid.
r
DATE: 08/08/2008 Clerk
Title
900549 5285969 PUBLISHER'S AFFIDAVIT
State of Indiana SS:
PtJBLIG @IOTICES� Hamilton County
I PUBLIC NOTICE OF
AOOPnONOFBFSOIAMON. Personally appeared before me, a notary public in and for said county and state,
cc- B&I"s -02
Notice is hereby given_
that the Common Council
Of the City of Carmel Indi- the undersigned Karen Mullins who, being duly sworn, says that SHE is clerk
a did on August 4, 2008
ado ppt Resolution CC -08-
114 -08 -02 approving a ten
g a so n al fo PMagno of the Noblesville Ledger a newspaper of general circulation
Ilia Healthcare (Pharma-
kon Compounding Phar-
macy and ko
Long Term Care are P har printed and published in the English language in the city of NOBLESVILLE in state
Macy, Inc.) for its invest
men, in a new cos orate
headquarters t and count aforesaid, and that the printed matter attached hereto is a true of new information tech- Y P copy,
nology equipment tele-
communications, labora-
tory, and research which was duly p ublished in said p aper for I times
development equipment. Y P P P between the dates of:
I This Resolution, which af-
fects the following de-
scribed pro erty located
in the cit ol?Carmel, Indi- I 08/08/2008 and 08/08/2008
aria; 80 Congressional
Blvd., Clay Township,
Hamilton County 4-
scribed in 1Y,1, A of
hi it
Resolution CC- OS -04 of
("the Property was Q Ier k adopted following th fil- ing of information, by Ttle
Magnolia Healthcare as I
an Economic Revitaliza-
tion Area for the purpose
of securing a ten-year per Subscribed and sworn to before me on 08/08/2008
sonal property tax abate-
ment pursuant to Indiana
Code Section 6 -1.1- 12.1 -4, i
the in August
at
at 6 .m. in the Council I
Chamber Room, located at
One Civic square Carmel,
Indiana, 46032, the Com- Notar Public
mon Council will receive Y
all remonstrances and ob-
jections from interested
I persons, regarding these DENISE HAMBRITE
I proceedings. A descrip-
Form 65 REV I -88 tion of the property and a M commission ex Tres: NOTARY
cop of Resolution cc -08 -c. Y P AL
PU
04 %-02 are available for
inspection in the Hamilton J STATE OF INDIANA
County Assessor's, office,
Suite 214, 33 North 9th MY COMMISSION EXPIRES February 28, 2036
Street, Noblesville, Indi-
ana 46960.
For additional information
on the project, contact Ka-
tie Culp Senior Vice Presi-
dent, Colliers Turley Mar
tin Tucker 311- 6369 -0485- r
5285969)
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
I h`' Purchase Order No.
4`C Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
lqv
b
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 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
S bill(s) is (are) true and correct and that the
materials or services itemized thereon for
I which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund