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HomeMy WebLinkAbout156652 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 ROOM 201, STATE HOUSE CHECK NUMBER: 156652 INDIANAPOLIS IN 46204 CHECK DATE: 2/21/2008 DEPAR ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4358300 5.00 SNYDER January 25, 2008 City of Carmel Denise Snyder One Civic Square Carmel, IN 46032 Dear Denise: Enclosed is the Notary Public application you requested. Please complete items 1 through 8 and sign where indicated by the "X" on items 9 and 10. A notary public needs to complete items 9 and 11. Please return the completed application to me along with two checks, $5.00 made payable to the Secretary of State and $50.00 made payable to Hylant Group. (Please note these charges apply per notary bond.) Upon receipt of the completed application in our office, we will forward onto the company for issuance. Please feel free to contact me if you have any questions. Sincerely, HYLANT GROUP i I I f Sue Morlock Enclosure i S f i i 1 I I NOTARY APPLICATION INSTRUCTIONS I. Application for Notary Public may be obtained from the Secretary of State, the Clerk of the Circuit Court, or a bonding company. Applications can be photocopied if all parts of the application remain on the front and back of one piece of paper. 2. The application must be filled out completely. The application must be typewritten or printed. Do not leave any blanks. If any item is not applicable to you, please indicate that fact with the words "not applicable" or "none" or "NA II. 3. In giving your name in item #1 on the application, you should print or type your name the way you will sign your name as a notary public. Your first or middle name may be initialed, but we suggest either your first full name or your second full name or both, whichever you prefer. For example: John S. Smith, J. Samuel Smith, or John Samuel Smith; but not J. S. Smith. Your commission will be issued in the name given in item #1 and when performing a notarial act you should always sign your name the way it appears on your commission. This requirement is for identification purposes and is for your protection. 4. If you are making reapplication, it is important for you to complete item #7 on the application and show your ex- piration date so that when your new commission is issued there will be no lapse or overlap. (Ifyour commission has recently expired, do not show your old expiration date in #7. Show an. expiration date only if your commission is still in effect when you complete the application) Reapplications should not be sent to the Secretary of State's office earlier than sixty (60) days before the expiration date. 5. After the first seven items of the application have been filled out, take the application to an officer authorized by law to administer oaths (e.g. another notary public, the Clerk of the Circuit Court, etc.). The oath of office (item #9 of the application) will be administered to you by that officer. Be sure to read instructions 96, 7, 8, 9 and 10 below. PLEASE NOTE: BEFORE TAKING THE OATH IT IS IMPORTANT TO DETERMINE IF YOU ARE QUALIFIED TO BE A NOTARY PUBLIC. A. INDIANA LAW STATES THAT IT SHALL BE AN INDISPENSABLE QUALIFICATION FOR PERSONS TO HOLD ANY OFFICE WITHIN THE STATE OF INDIANA, EITHER BY ELECTION OR APPOINTMENT, THAT SUCH PERSONS SHALL NEVER HAVE BEEN CONVICTED OF ANY CRIME AGAINST THE LAWS OF THE UNITED STATES WHERE THE SENTENCE IMPOSED EXCEEDED SIX (6) MONTHS (IC 5- 8 -3 -1). B. NO PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER THE UNITED STATES OR UNDER THIS STATE, AND PROHIBITED BY THE CONSTITUTION OF THIS STATE FROM HOLDING MORE THAN ONE SUCH LUCRATIVE OFFICE, SHALL SERVE AS A NOTARY PUBLIC, AND HIS ACCEPTANCE OF ANY SUCH OFFICE SHALL VACATE HIS APPOINTMENT AS SUCH NOTARY; BUT THIS PROVISION SHALL NOT APPLY TO ANY PERSON HOLDING ANY LUCRATIVE OFFICE OR APPOINTMENT UNDER ANY CIVIL OR SCHOOL CITY OR TOWN OF THIS STATE. (IC 33- 16 -2 -7) C. EVERY PERSON ELECTED OR APPOINTED TO ANY OFFICE UNDER THIS CONSTITUTION SHALL, BEFORE ENTERING ON THE DUTIES THEREOF, TAKE AN OATH OR AFFIRMATION TO SUPPORT THE CONSTITUTION OF THIS STATE, AND OF THE UNITED STATES, AND ALSO AN OATH OF OFFICE. (Indiana Constitution, Article 15, Sectio n 4) 6. An official bond, with freehold or corporate security, must be secured in the sum of $5,000. The applicant must sign in item #10 and have his signature acknowledged in 411. (Freehold security must be approved by the Secre- tary of State and item #13 of the application is only completed in the case of a freehold bond. A freehold bond is when someone other than the applicant, who owns land worth at least $5,000, is the surety.) Corporate security can be obtained by taking the application to a bonding company for completion. Insurance companies and agents are often qualified to provide corporate security. Items 410, 11 and 12 of the application make up the bond. 7. In the case of a corporate security, a power of attorney showing that the individual signing for the bonding company has authority to execute the bond should be attached to the application when it is submitted to the Secretary of State. i 8. The completed application, including the oath of office and bond, should be forwarded to the Secretary of State with a fee of five dollars ($5), payable to the Secretary of State, in the form of a check or money order. Do not send cur- rency in the mail. 9. The Secretary of State will forward your commission to you (or to your surety company, if requested to do so by enclosing a self- addressed return envelope with the application.) 10. Please tear off and keep these instructions. i s State Forth 40889 (R7 1-03) Approved by State Board of Accounts 1997 TODD ROKITA SECRETARY OF STATE NOTARY PUBLIC APPLICATION* Including: Request to be appointed a Notary Public Notarial Oath Notarial Bond Instructions IC 33- 16 -2 -1: (as amended) Sec. 1 (a) Any applicant for a commission as a notary public shall possess the following qualifications: (1) be at least eighteen (18) years of age; and (2) be a legal resident of the State of Indiana. (b) A notary public shall be appointed and commissioned by the Governor. A notary public shall hold office for eight (8) years. A notary public, when so qualified, shall be authorized to act within the State of Indiana. A person may request an application to become a notary public from the Secretary of State. The application shall be prescribed by the Secretary of State and shall include the applicant's county of residence, oath of office, and official bond. The application shall also contain any additional information necessary for the efficient administration of this chapter. The applicant shall personally appear, with an application, before an officer authorized by law to administer oaths who shall administer an oath of office to the applicant. The applicant shall secure an official bond, with freehold or corporate security, to be approved by the Secretary of State in the sum of five thousand dollars ($5,000). The official bond shall be conditioned upon the faithful performance and discharge of the duties of the office of notary public, in all things according to law, for the use of any person injured by a breach of the condition. The completed application shall be forwarded to the Secretary of State. The Secretary of State shall forward each commission issued by the Govemor to the applicant or the applicant's surety company. Notary Department Secretary of State's Office Room 201 State House Indianapolis, Indiana 46204 317- 232 -6542 This application should also be filled out by current notaries public desiring to extend their commission for another term. There is no separate renewal form or procedure. IT IS A CRIME TO PERFORM ANY OF THE DUTIES OF A NOTARY PUBLIC UNTIL COMMISSIONED BY THE GOVERNOR. IT IS IMPORTANT THAT YOU POSSESS A CURRENT, VALID COMMISSION BEFORE ACTING AS A NOTARY PUBLIC. THE FILING OF THIS APPLICATION OR THE TAKING OF THE OATH CONTAINED AS PART OF THIS APPLICATION DOES NOT AUTHORIZE YOU TO ACT AS A NOTARY PUBLIC. Do Not Write In This Box For Office Use Onl Commission Expiration Date of New Commission 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 -6542 To: THE GOVERNOR OF INDIANA I respectfully request that I be appointed and commissioned a Notary Public. In support of my application, I submit herewith the required bond, oath of office, and jee of FIVE DOLLARS ($5), payable to the Secretary of State, in thejorm of a check or money order. (Do not send currency in the mail) (IC33- 16 -2 -1) PRINT OR TYPE 1. NAME Your I egal signature in which commiss ion wd1 be tuued -s a huavG ion #3 2. HOME ADDRESS 3��� S�� -����5 \v s Munber and street City Slate ZIP code 3. COUNTY OF RESIDENCE 4. Business or Employer's Name 5. Business or Employer's Address sirect City State ZIP code 6. HOME PHONE y�� �a OFFICE PHONE (���y Shy g p Ar© Cade Numhcr Area Code Number 7. If you have a current valid notary commission, show your expiration date: 8. If you are now a notary public and your name or county has changed since your last application, please give both old and new information. OLD: NEW: 9. NOTARIAL OATH STATE OF INDIANA SS: COUNTY OF (fit °n� ounty in which oath is s Rrn ntstcred I do solemnly swear (or affirm) that I will support the Constitution of the United Stases, and the Constitution of the State of Indiana; that I am duly qualified to hold office under the Constitution and laws of the State; that I am 18 years of age or over; that I am of good moral character and integrity; that I am a resident of Indiana; that my answers to questions on this application are true and complete to the best of my knowledge; that I have carefully read all of the instructions which came with this application, and that I will faithfully and impartially discharge the duties of NOTARY PUBLIC if so commissioned by the Governor, according to the best of my skill and ability, so help me God (or under the pains and penalties of ped ury)• r signature of appiicam Place 0Nice S :zi Here Subscribed and sworn or affirmed to before me, this day of A.D. 20 b$ IN TESTIMONY WHEREOF, 1, 0 xm M \Tun1 r tnoff Print r typed na �i me ofoe cr r o�icc athid r a /0779 -o,U c for the 0 c A P-4 DN State of Indiana issionexpires: NOTE: The Bond Form, starting with #10 on the back of this application, must be completed before mailing to the Secretary of State. The applicant must sign again in #10. 10. NOTARIAL BOND KNOW ALL BY THESE PRESENTS, that we (applicant) and Nane ofApplicant as principal Nameof Sumty of Soataciam". city. am &zlpeode and County as freehold or corporate surety, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents. WITNESS our signatures as acknowledged below. THE CONDITION OF THE ABOVE OBLIGATION IS AS FOLLOWS, TO -WIT. WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a Notary Public, in and for the State of Indiana, for a eight -year term. Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then the above obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principal's commission to the expiration date of the same. Signaure orapplictmt. Mustbe xk o%icdgcdbdowinpt ]l. ACKNOWLEDGEMENT OF APPLICANT'S SIGNATURE BY A NOTARY PUBLIC OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. STATE OF lib R-N g- COUNTY OF 1'4 A ON Countymwaxnadsnowkdgencete bcangmadc :SS: Before �m�e- the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk etc.) personally appeared and acknowledged the execution of the foregoing bond for the uses and Printed or typed name of appdtemi purposes th -rein expressed, without condition or reservation. P;ac- tifPscrs seat were IId TESTIMONY WHEREOF, I 0 M O Z Punted or have hereunto set my typed tumeoro4ica hand and i fficial seal, ms is day of 1;E A/Lt t 1 20 0 n 6 l a signmwe arauth arn¢r 1 IY� i�tLl 17 J�1 o cc for the County of State of a6l a-A •Of cvumy ofra idcace My commission expires: t 12. ACKNOWLEDGEMENT OF SURETY'S SIGNATURE (Freehold or Corporate) BY A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED BY LAW TO TAKE ACKNOWLEDGEMENTS. (NOTE: 71re officer can not acknowledge hisA:er own signature) STATE OF COUNTY OF County in which arknowiedgement is berg made S$ Before me the undersigned, an officer authorized to take the acknowledgement of deeds (Notary Public, County Clerk, etc.) personally appeared Printed ortypcdnameafindi .•idualsigningusu¢ and acknowledged the execution ofthe foregoing bond for the uses and h purposes therein expressed, without condition or reservation. Place Officer's seal here IN TESTIMONY WHEREOF, I Printed or typed name oro0iea have hereunto set my hand and official seal, this day of 20 Sigra 01 aalhOfl' M orrkr a for the County of fli C 0 State of Officers countyafre idercc My commission expires: 13. SUPPORTING AFFIDAVIT TO BE USED IN SUPPORT OFA FREEHOLD SURETY. STATE OF INDIANA, COUNTY OF SS: Courry in which oe4nowlodgeetemu being mnde The undersigned surety, being duly sworn or affirmed, says that he /she is the owner in fee simple of Real Estate in County, of the fair Cash Value of S over and above all encumbrances and exemptions. Signature orsurety Place Officer's seal here IN TESTIMONY WHEREOF, I have hereunto set my Hated or typed raT a of o(riec t hand and official seal, this day of 20 Signal ux of au. ".orized ofCzxr a i office for the County of State of I orbeers oounty ofraid ice j My commission expires: iy i For the statute pertaining to surety company bonds, see Indiana Code 27 -1 -22. For the statutes pertaining to Officers Bonds and Oaths, see Indiana Code 5A. I i I 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)) Total S o o_ 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 ao 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 30 0� oaos� j Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund