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