168442 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
z.. ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITI&ECK AMOUNT: $106.00
CARMEL, INDIANA 46032 BOILER AND PRESS VALVE SAFETY D €V
o 302 wWASHINGTON ST, RM 246 CHECK NUMBER: 168442
INDIANAPOLIS IN 46204 -2739
a CHECK DATE: 214!2009
DEPARTNi�NT ACCOUNT PONUMBER INVOICE NUM AMOUNT DESCRIPTION
1047` 4350100 304619 105.00 BUILDING REPAIRS MA
I
F�
INVOICE FOR INSPECTION J CERTIFICATE FEES
State Form 356 (R4 9 -93)
Approved by the State Board of Accounts 1991
`010,.;on of Fire and Building Safety
1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY
INSTRUCYIONS: 2. Mail 2nd copy& check to DEPARTMENT OF HOMELAND SECURITY JAN 4 2009
4 Boiler and Pressure Vessel Safety Division
302 W WASHINGTON ST., RM 246
INDIANAPOLIS IN 46204 -2739
Telephone: (317) 232 -1921
LATEST
INVOICE
INDIANA DATE PLEASE
CARMEL CLAY !?ARKS RECREATION PAY THIS
NUMBER
ATTN JEREMIAH KERR AMOUNT!
304619 1411 E 116TH ST 12/29/2008
CARMEL, IN 46032
User Name Location of vessel THE MONON CTR Fee
Owner number 1235 CENTRAL PARK DR E
CARMEL IN 46032 105.00
Serial number Description of vessel Manufacturer Date Last Inspected
W T B1r Hot Water Heating BRYAN 12/02/2008
National Board No. Inspection agency Name of inspector (This fee is
53252 STATE OF INDIANA PARKEY LARRY E prescribed by
IC 22- 12 -6 -10)
PurOhaea
Descrlptldl1 !_dLk hak 1 y1
P.O. P or F
G.L.
Budget n
Line Descr
Purchaser Gate
Approval Date
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An in'100ice 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.
Department of Homeland Security Terms
Boiler and Pressure Vessel Safety Div.
302 W Washington St., Rm 246
Indianapolis, IN 46204 -2739
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/08 304619 Water heater inspection 105.00
Total 105.00
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.
b
Department of Homeland Security Allowed 20
Boiler and Pressure Vessel Safety Div.
302 W Washington St., Rm 246
Indianapolis, IN 46204 -2739 In Sum of
t
105.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
V PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 304619 4350100 105.00 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
27 -Jan 2009
Signature
105.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
i
i
J