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HomeMy WebLinkAbout204265 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI CHECK AMOUNT: $240.00 of CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY- FISCAL OFFI C 302 W WASHINGTON ST, RM E221 CHECK NUMBER: 204265 INDIANAPOLIS IN 46204 CHECK DATE: 12/612011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4358300 240.00 734241112920111 ELEVATOR OPERATING CERTIFICATE INVOICE ARMEL /CLAY BOARD OF PARKS RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032 1.If Code An annual test report is due before a permit is issued. 2-If Code A 5 year Test report is due before a permit is issued. 3.Over due fees must be paid before a permit is i ssued. If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. State No Due Over Due Location Address 111704 $120.00 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032 111978 $120.00 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032 G.L. 1 0 NOV 3 0 2011 Reference Number, _Invoice_Date Please submit ENTIRE document with payment (734241- 11292.011 1 C11/_29/_2011, Unit(s) 2 Total Due upon receipt._______ of 2 240.00 of $(_.240_'.0.0.._ Owner Id 734241 Ref.Num.:734241- 11292011 -1 $240 of 240.00 Invoice Date 11/29/2011 If Paying by check, include a check made payable to the�Depar of.Homeland 'security: You can pay all your payments online at IDHS web site https:// myoracle. in. gov/ dfbs /idhsieejFin i6 /start:do -wi h Visa /Master Card /Discover cards. use Owner Id on this letter or State Number on the invoice to_p u p_information when paying the dues online.OR_ complete the following information and return by mail :'Indiana DepartmenE of Homeland Security, Department, 302 W.Washirig ton'St 'E221, Indianapolis, IN 46204 or fax -to (317)233 -0401. Questions? calh(317')' 232- 6427 E- mail:elevator- invoice ®dhe in.gov -2:25% convenience fee charged on all credit card payments. Full Name on Credit Card Billing Address: Street City State Zip Code Credit Card: American Express /Discover /Master Card /Visa ONLY (circle one) Acct. Number Exp.Date (mm /yy) CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's Agreement with the issuer. G L ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 229400 Indiana Department of Homeland Security Terms Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 11/29/11 734241112920111 Annual elevator permit 240.00 Total 240.00 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. 229400 Indiana Department of Homeland Security Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of 240.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #,rr[TLE AMOUNT Board Members Dept 1091 734241112920111 4358300 240.00 1 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 1 -Dec 2011 Signature 240.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund