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Home My WebLink About160027 05/28/2008 I CITY OF CARMEL, INDIANA VENDOR: 241763 Page 1 of 1 ONE CIVIC SQUARE PETTY CASH CARMEL, INDIANA 46032 C/O LISA CHECK AMOUNT: $147.20 ti�rbn C/O LISA CHECK NUMBER: 160027 CHECK DATE: 5/28/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION :601 5023990 147.20 OTHER EXPENSES i i l a Bureau of Motor Vehicles II VIII I II III II I I I I I I III II u Transaction Receipt a I t State Form 51717 (4 -04) Branch: CARMEL STARS (527) Date: 4/4108 Time: 8:59:32 am EDT Visit ID: 140199926 Visit Duration: 00:14:14 Visit Customer Visit Duration is the time elapsed from check in to transaction completion. CITY OF CARMEL WATER DEPT This time does not include testing time. 3450 W 131 ST ST WESTFIELD, IN 46074 -8267 Transactions Trans ID Trans Type Trans Subtype Amount 150105521 Title Initial Title Issuance New $36.00 150106125 Title Initial Title Issuance New $36.00 Subtotal: $72.00 Sales /Use Tax: $0.00 Total: $72.00 Payment Method Amount DL Number Authorization Number Name CREDIT $72.00 075927 Total Due: $72.00 Amount Paid: $72.00 Change Due: $0.00 r Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1 I Bureau of Motor Vehicles IIIIIIIIIIVIIIIII IIIIIIIIIIIIII II Detailed Transaction Receipt r BMV State Form 51714 (4 -04) ake E I Branch: CARMEL STARS (527) Date: 04/04/2008 Time: 8:59 EDT Visit ID: 140199926 CSR: SSY Visit Customer: CITY OF CARMEL WATER DEPT 3450 W 131 ST ST WESTFIELD, IN 46074 -8267 Transactions Trans ID Trans Type Trans Subtype Amount 150105521 Title Initial Title Issuance New Title Fee Vehicle $15.00 Delinquent Title, Vehicle $21.00 Vehicle: 1G13E5C1G08F410444 2008 CHE C5C CB Lien Holder: None Customer: CITY OF CARMEL WATER DEPT 3450 W 131 ST ST WESTFIELD, IN 46074 -8267 Purchase Date: 02/29/2008 150106125 Title Initial Title Issuance New Title Fee Vehicle $15.00 Delinquent Title, Vehicle $21.00 Vehicle: 1GBE5C1947F421964 2007 CHE C5C CB Lien Holder: None Customer: CITY OF CARMEL WATER DEPT 3450 W 131 ST ST WESTFIELD, IN 46074 -8267 Purchase Date: 02/01/2008 $72.00 Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1 s APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES r State Form 205 (R7 6 -04) Approved by State Board of Account 1997 rosecoMSLErEDSVA POLICE OFFICER. BMV OFFia 4LOR BMV CPP7PIEDDEALERSICNE i I/WETHEUNDERSIGNEDSWEARORAFFIRMTHATTHEINFORMA- FOR OUT OF STATE TITLES.( HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING I TION ENTERED ON THIS FORM IS CORRECT. I /WE UNDERSTAND v AND FI THE iD NU MBER TO BE as FOLLOW THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE, /WE AGREE TO INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY LIABILITY ARISING FROM THIS TRANSACTION. YR (MAKE MODEL ITYPE DATE 1 X X INSPECTOR'S PRINTED NAME TITLE CITY DATE The law requires that you apply for Cediflcate of Title within thirty -one days from the date of purchase of a (INSPECTOR'S SIGNATURE BADGE. BRANCH OR motorvehicle There is a delinquent fee of $21.00 for failure to do so. Attach Certificate of Title assigned by Beier On eo- DEALER PLATE NO. dorsed Titles, liens must be released. Supporting tlocumenls surrendered with this appllca0on cannot be returned to the appli- cant, State fee for applying for Title is S15.00. 1d accordance with Federal Code 383. j ,TITLE NUMBER IBRANCH NO INVOICE NO) BMV USE ONLY 1.i 04040852700004 527 I MV- GOVERNM C ERTIF I C AT E O F ORIGIN j "SOC SEC. /FEDERAL I.D. NO APPLICANT'S NAME BMV USE ONLY D 2 'i 35- 6 000972 CITY OF CARMEL WATER DEPT 0 (STREET ADDRESS CITY STATE ZIP CODE N 3 3450 W 131ST ST WESTF SIN 46074 -8267 o T VEHICLE J.D. NUMBER VEH. YEAR 'VEH MAKE VEH. MODEL NO. I VEH. TYPE ODOMETER ACTUAL 4. 1GBE 2007 i CHE I C5C TK 50M T FORMER TITLE NUMBER PURCHASE DATE LIEN SPEED I PICK UP i MAIL i DEALER NO. BMV USE ONLY Y 5.1 C O F O 02/01/2008 1 0 N N Yes P I E 'FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS 6. I N CITY STATE j ZIP CODE BMV USE ONLY 7. T H !SECOND LIEN'S NAME STREET ADDRESS 8. S 1 ICITY I STATE ZIP CODE j LICENSE NUMBER I LICENSE FORMS BMV USE ONLY Jl i, g l YEAR MUSED A SSY R I. E G IC ROSS RETAIL U SE TAX AFFIDAVIT I/WE HE C T HA T SALES O R US FAX ON THIS VEHICL WA PAID AS INDIC BELOW A (SELLING PRE LESS TRADE -IN DISCOUNT AMOUNT SUBJECT TO TAXAMOUNT OF TAX DEALER I BRANCH EXEMPT IF EXEMPT PLACE PARA.# 10. l o.00 0.00 0.0 -X 'Your Social Security number/ Federal I number is being requested by this agency under IC4- 1 -8 -1. Disclosure is mandatory and this document cannot be processed without it APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES II VIII VIII III II I II I II II II II II VIII III I II I 2 0 5 1 5 0 1 0 6 1 2 5 f APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES State Form 205 (R7 6 -04) Approved by State Board of Account 1997 TO BE COM BY A POLICE OFFICER, BMV OFFICIAL OR. BMV CERTIFIED DEALER SONEE i I/WETHEUNDERSIGNEDSWEARORAFFIRMTHATTHEINFORMA- FOROUTOF STATE TITLES. I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING TION ENTERED ON THIS FORM IS CORRECT. I /WE UNDERSTAND VEH CI_E AND FIND THE IDENTIFICATION NUM TO BE A FOLLOWS I THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE, IJWE AGREE TO I I L I INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY LIABILITY ARISING FROM THIS TRANSACTION. YR !MAKE MODEL TYPE DATE X INSPECTOR'S PRINTED NAME TITLE CITY X I_ DATE li -!The law requires that you apply for Certificate of Title within thirty -one days from the date of purchase of a INSPECTOR'S SIGNATURE BADGE, BRANCH OR 1 molorvehicle. There is a delinquent fee of $21.00 for failure to do so. Attach Certificate of Title assigned by seller. On en- DEALER PLATE NO. dorsed Titles, liens must be released. Supporting documents surrendered with this application cannot be returned to the appl'r cant. State fee for applying for Title is515.00,'in accordance with Federal Code 383. ITITLE NUMBER BRANCH NO INVOICE NO'J BMV USE ONLY j 04040852700003 527 MV- GOVERNM CE RTIFI CATE OF OR `SOC. SEC. /FEDERAL I.D. NO APPLICANT'S NAME BMV USE ONLY D 2. 35- 6000972 CITY OF CARMEL WATER DEPT 0 STREET ADDRESS CITY STATE ZIP CODE N 31 3450 W 131 ST ST WESTFIELD SIN 46074 -8267 0 VEHICLE I.D. NUMBER VEH. YEAR 'VEH. MAKE VIER MODEL NO. VEH. TYPE ODOMETER ACTUAL T 4. 1GBE5 2008 1 CHE 05C TK 100 M T FORMER TITLE NUMBER PURCHASE DATE j LIEN ;SPEED I PICK UP MAIL DEALER NO BMV USE ONLY Y 5. O F O i 0 2/29/2 008 0 No N Y E FIRST LIEN'S NAME OR SPECIA L MAILING ADDRESS 1 STREET ADDRESS 6. j L _iN CITY I STATE i ZIP CODE 1 BMV USE ONLY 7. T H SECOND LIEN'S NAME STREET ADDRESS 1 8. S CITY STATE jZIP CODE LICENSE NUMBER LICENSEI FORMS BMV USE ONLY 9 YEAR USED SSY R E GROSS RETAIL USE TAX AFFIDAVIT I /WE HERE CE RTIFY THA SA LES OR US TAX ON THIS VEHICLE WAS PAID A IND BELOW A SELLING PRICE LESS TRADE -IN DISCOUNT j AMOUNT SUBJECT TO TAXIAMOUNT OF TAX DEALER BRANCH 'EXEMPT! IF EXEMPT IS PLACE PARA.# 10 '1 0.00 0.00 0.00 0.00 X 'Your Social Security number/ Federal I.D. number is being requested by this agency under IC4- 1 -8 -1. Disclosure is mandatory and this document cannot be processed without it APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES i IIIIIII I II I II III I III I 2 0 5 1 5 0 1 0 5 5 2 1 Prescribed by State Board of Accounts Form No. 301 Rev. 1995) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount I 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 Mo. Day Yr. Signature Title 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. Mo. Day Yr. Officer Title Voucher No Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ANO. CARMEL, INDIANA Favor Of QcHr� Cis h Total Amount of Voucher Deductions o .63 O.D 6;60 O or. 65co o Amount of Warrant 7 At- Month of Yr VOUCHER RECORD Acct. No. Source of Supply Water Treatment Transmission and Dist. Customer Accounts Administrative and General Operation-Maintenance Utility Plant in Service Constr. Work in Progress Materials and Supplies Customers Deposits Total Allowed Board of Control Filed Official Title BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325