178113 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITI&ECK AMOUNT: $65.00
(f CARMEL, INDIANA 46032 BOILER AND PRESS. VALVE SAFETY DIV
302 W WASHINGTON ST, RM 246
CHECK NUMBER: 178113
`�,o�
INDIANAPOLIS IN 46204 -2739
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 092409 65.00 OTHER EXPENSES
A
'T4F INVOICE FOR INSPECTION CERTIFICATE FEES
State Form 356 (R4 9 -93)
T Approved by the State Board of Accounts 1991
Division of Fire and Building Safety
1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
INSTRUCTIONS: 2. Mail 2nd copy 8 check to DEPARTMENT OF HOMELAND SECURITY
Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS W 46204 -2739
Telephone: (317) 232-1921
LATEST
INVOICE PLEASE
INDIANA DATE
PAY THIS
NUMBER
CARMEL CITY OF AMOUNTI
308699 1 CIVIL SQUARE 09/24/2009
CARMEL, IN 46032
Owner number User Name S Location of vessel CARMEL WASTE WTR UTILITIES Fee
9609 HAZEL DELL PKWY
CARMEL IN 46280 65.00
Serial number Description of vessel Manufacturer Date Last Inspected
FT Boiler HURST 08/25/2009
National Board No. Inspection agency Name of inspector (This fee is
14935 STATE OF INDIANA PARKEY LARRY E prescribed by
675 IAC 12 -3 -13)
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
362497
DEPARTMENT OF HOMELAND SECURITY Purchase Order No.
BOILER AND PRESSURE VESSEL SAFETY DI% Terms
302 W WASHINGTON ST RM 246 Due Date 10/6/2009
INDIANAPOLIS, IN 46204 g
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill Amount
10/6/2009 092409 $65.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 096528 WARRANT ALLOWED
162497 IN SUM OF
DEPARTMENT OF HOMELAND SECUF
BOILER AND PRESSURE VESSEL SAF
302 W WASHINGTON ST RM 246
INDIANAPOLIS, IN 46204
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
092409 01- 7362 -05 $65.00
Voucher Total $65.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
3