166730 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00352162 Page 1 of 1
ONE CIVIC SQUARE INDIANA SECRETARY OF STATE
CARMEL, INDIANA 46032 BUS SVS DIV ATTN: CORP REC CLERK CHECK AMOUNT: $20.00
o?� 302 W WASHINGTON ST, ROOM E018
CHECK NUMBER: 166730
INDIANAPOLIS IN 46204
CHECK DATE: 12/10/2008
bEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
852 5023990 20.00 OTHER EXPENSES
I
Page 1 of 1
2004080600242 Print this report using the print function on your browser.
INDIANA BUSINESS ENTITY REPORT INSTRUCTIONS:
Prescribed by Todd Rokita, Secretary of State 1) Review and edit secions A E.
Information: 2) Make check payable to the Indiana Secretary of State.
in.govls 3) Sign at bottom of form.
www.in.gov/sos www. 232 -65 o 4) Mail form and check to:
Indiana Secretary of State
302 W. Washington Street, Room E -018
Indianapolis, IN 46204
Filing year(s) 2007 2008
A) Entity name and current principal address Please make any changes to the address here:
CARMEL SWAT ASSOCIATION, INC.
3 CIVIC SQ
CARMEL, IN 46032
Entity Creation Date Domicile State
8/5/2004 INDIANA
Entity Type
Non Profit Corporation
B) Current registered agent and registered address Please make any changes to agent and the address here:
MICHAEL PITMAN
3 CIVIC SQUARE
CARMEL, IN 46032
C) Current principal(s) and address(es) Please make any changes to officer(s) and the address(es) here:
President or highest officer:
SHANE COLLINS
3 CIVIC SQUARE
CARMEL, IN 46032
Secretary or other officer: n
BARINTRIWY44— PI-7ynW
3 C
CA m .46032-
D) Directors
All entity types except LLCs complete this section. List the name and address of current director(s). (Attach additional sheets if necessary.)
Name Address
E) SIGNATURE FILING FEE: $20.00
Must be signed by a corporate offs hairman of the
board or by a member or manaqe55&ran LLC.
*THIS FORM MUST BE SIGNED TO BE ACCEPTED*
2004080600242
https: /secure.in.gov /sosfbus service /0nline corps /corp_report/print and_mail entity repo... 12/2/2008
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
Indiana Secretary of State Purchase Order No.
302 W. Washington Street, Room E018 Terms
Indianapois, IN 46204 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1 2/3/08 payMent to bring SWAT Association current to dissolve-- 20.00
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
In3iana Secretary of State IN SUM OF
302 W. Wasington Street, Room E018
Indianapolis, IN 46204
20.00
ON ACCOUNT OF APPROPRIATION FOR
police gift -fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
852 852 20.00 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
December 3 20 08
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund