HomeMy WebLinkAbout156655 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 279200 Page 1 of 1
ONE CIVIC SQUARE INDIANA SECRETARY OF STATE
CARMEL, INDIANA 46032 NOTARY DEPARTMENT CHECK AMOUNT: $5.00
'M p ROOM 201, STATE HOUSE CHECK NUMBER: 156655
INDIANAPOLIS IN 46204
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4341999 CHASTAIN 5.00 OTHER PROFESSIONAL FE
V
FEB -15 1 2008 FRI 09:18 AM H. J, Spier Co, ,Inc, FAX K 3178498800 P, 03
Do Not Write In This Box For Office Use Onl
Commission Expiration Date of New Commisslon
APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC IN THE STATE OF INDIANA
'Complete and Return to: Notary Department, Secretary of State, Room 201, State House
Indianapolis, Indiana 46204: Telephone: 317- 232 -5542
To: THE GOVERNOR OF INDIANA
I respectfully request that 1 be appointed and commissioned a Notary Public. In support of my application, I submit herewith the required bond,
oath of office, and fee of FIVE DOLLARS ($5), payable to the Secretary of State, in the form of a check or money order (Do not send currency In
the mail,) (IC 33- 16 -2.1)
PRINT OR TYPE
I. NAME Jenny A ChaGtain
Your opal aipnature In whldl commlealon Will be Issued eee Irrotructlon 03
2. HOME ADDRESS 511 Second Avenue NE
Nmgber end street
Carmel IN 46032
city SION 21P coda
3. COUNTY OF RESIDENCE Hamilton
4. Business or Employer's Name City of Carmel
5. Business or Employer's Address One Civic Square Carmel IN 46032
8treot My state 211 codo
6, HOMI =RHONE (317) 566 8812 OFFICE PHONE (317) 571 -2483
Area Cade Numbw Area Code Numbor
7. If you have a current valid notary commission, show your expiration date;
S. If you are now o notary public and your name or county has changed since your last application, please give both old and new information.
OLD:
NEW:
9, NOTARIAL, OATH
STATE OF INDIANA i SS:
COUNTY OF I County i vibIch oath l`a m n ertsTl ea
I do solemnly swear (or affirm) that I will support the Constitution of the United States, and the Constitution of the State of Indiana; that I am duly
qualified to hold offloe under the Constitutlon and laws of the State; that I am 18 years of age or over; that I am of good moral character and Integrity;
that I am a resident of Indiana; that my answers to questions on this application are true and oomplato to the best of my knowledge; that I have
carefully read all of the instructions which came with this applloaUon, and that I will faithfully and impartially discharge the duties of NOTARY
PUBLIC If so commissioned by the Governor, according to the best of my skill and ability, so help me God (or under the pains and penalties of
$Ipnalwro of appllanl
Place Of(Icor's soar Hers Subsorlbed and sworn or affirmed to before ma, this day of
A.D. 20 C A IN TESTIMONY WHEREOF, I,
l `fi ti o typed name of ofttdor
SI� r-► 7 _1 0 1 J t, a �aC N L` for the
L a of s notary pubp ;G o administer oaths otpca
County of State of Indlana.
e n a
My commission expires; p'2J� C-)_0
NOTE; The Bond Form, starling with #10 on the back of this a plication, must bo completed before mailing to the Secretary of State.
The applicant must sign again in #10.
NEO 0697 IN (1103)
FEB -15 -2008 FR 09;18 AM H.I Spier Co,.InC. FAX N0, 3178498800 P. 02
10. NOTARIAL BOND Bond No. 'IN
KNOW ALL BY THESE PRESENTS, that we as principal
wae of Apptfcanl
(applicant) and Merchants Bonding Company (Mu of
2100I7eur Drive Des Moines, Iowa 50321 -1158 Name of -Surety
and polls County as
Street addranc, city, state B LP code
freehold or corporate surety, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the
payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents.
WITNESS our signatures as acknowledged below. THE CONDITION OF THE ABOVE OBLIGATION IS AS FOLLOWS,
TO-WIT.
WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a
Notary Public, in and for the State of Indiana, for a eight -year term.
Now, if the. said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public, In all things according to
law, then the above obligation to be null and vold, otherwise to remain In full force and virtue in law. The term of this bond is from the effective
date of the princi I's commission to the expiration date of the same.
6 1,
8" Eve of appicont be amnowiadoed below in #11 Slonsture of surety. Must bib adcnowWged below In #12
11. ACKNOWkEDGEMERYOF APPLICANTS SIGNATURE BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY
LAW TO TAKE ACKNOWLEDGEMENTS n
STATE OF 0- COUNTY OF Y :SS:
County In whlah aeltnowkdparnent is being rnado
Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc.) personally appeared
Jenny A. Chastain and acknowledged the execution of the foregoing bond for the uses and
Pdntod or d name of applkenl
purposes therein expressed, wlthout or reservation.
Place o fflooWs seal here IN TESTIMONY WHEREOF, I have hereunto set my
Printed typaq memo of offloor
hand and official seal, this day of 20 (J D
a
SloneWif o u Azad officer office
for the County of State of
My commission expires: o C- �.Il.� r r J oZ b I 7
12. ACKNOWLEDGEMENT OF SURETY'S SIGNATURE (Corporate) BY A PUBLIC OR OTHER OFFICER
AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS (NOTE. The officer cannot acknowledge hislher own signature)
STATE OF COUNTY OF SS:
County in wNcn scknowieRadrrwnt Ic being mado
Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc.) personally appeared
Printed or lopes nema of individual alining as surety and acknowledged the execution of the foregoing bond for the uses and
purposes therein expressed, without condition or reservation.
Place omcar real hero IN TESTIMONY WHEREOF, I have hereunto set my
PrlrUod or typed name of otricar
hand and official seal, this day of 20
,a
slgnaturo of authorized officer office
for the County of State of
Ottlowa county of rdddonon
My commission expires:
For the statt.lte p ertaining to surety company bonds, see Indiana Code 27 -1 -22. For the statutes pertaining to Officer's Bonds and
Oaths. soo Indiana r:nAA .ri.d
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Notary Department, Secretary of State
Purchase Order No.
Room 201, State House
Terms
Indianapolis IN 46204
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Notary Commission for Jenny A. Chastain per the $5.00
attached "Application For Appointment As A Notary
Public In The State Of Indiana"
Total $5.00
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
n'.otary Department Secretary of Sta
IN SUM OF
Room 201, State House
Indianapolis IN 46204
5.00
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1160 $5-00 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
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund