Loading...
168386 02/04/2009 a«, CITY OF CARMEL, INDIANA VENDOR: 360614 Page 1 of 1 ONE CIV!C,SQUARE BUREAU OF MOTOR VEHICLES CARMEL, INC:IANA 46032 REGISTRATION DIVISION- SPECIAL PLAT CHECK AMOUNT: $15.00 100 N SENATE AVE N404 'tir „�o` CHECK NUMBER: 16$386 INDIANAPOLIS IN 46204 CHECK DATE: 2/412009 DEPART AC PO NUMBER INVOI NUMBER W AMOUNT DESCRIPTION 1125 4351000 15.00 AUTO REPAIR MAINTEN o Carmel OCI Parks &Recreation CHECK REQUEST Date: 1 I Zq ©q CETVED JAN 2 9 2009 Check payable to r BY: Name: W w o, A ,O�� fit' t"U1Tl� Y� r,YC N. s Address: ono City, State, Zip 0 L t s t Mail check to payee Return check to requestor Check Amount [5,90 Date Required OP Check needed for �'�Ck at, e I Q--AILS- jr 4661 VhTif, (P09) To be paid from PO (if applicable) Budget account GL Budget Line Description eWn U r Z �A/l:'. Invoice(s) and Purchase Order (if required) MUST be attached. Requested by (print): ors Requested by (signature): Approved by (signature of Division Manager): on this date j Z Form revised 7 -7 -08 Shared Administrative Forms Staff forms Check Request (rev 7 -7 -08) Carmel Clay Parks Recreation 1427 E. 116`' Street Carmel, IN 46032 January 19, 2008 Dear Customer: Enclosed find the title work necessary to title, register and plate the vehicle you recently purchased at Pearson Ford. If you have any questions or concerns, please call me at 317-733-6039. Thank you for purchasing your vehicle at Pearson Ford. PAS N Sincerely, FOR A LIFETIME. Jim Dent Title Clerk 10650 North Michigan Road Zionsville, Indiana 46077 317.873.3333 www.pearsonford.net State Form 44049 (R4 13 -02) Approved by Stale Board of Accounts 2002 TOFF COMPLETED B: APOUCE OFFICER, BMV OFFICIAL OR BMV CERTIFIED DEALERSIGNEE I/WE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA FO. t`, OUT OF STATE TITLES. I, HEREBY` CERTIFY THAT I PERSONALLY EXAM TION ENTERED ON THIS FORM IS CORRECT. UWE UNDERSTAND INED'THEFOLLOWING VEHICLEAND F114D THE IDENTIFICATION NUMBERTOBEAS FOLLOWS. THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE, UWE AGREE TO INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY LIABILITY ARISING FROM THIS TRANSACTION. 13. t) YR. MAKE MODEL TYPE DATE X X INSPECTOR'S PRINTED NAME TITLE CITY DATE: The law requires that you apply tar Cenificale o! Tule within thirty one days from the date of purchase of a INSPECTOR'S SIGNATURE BADGE, BRANCH OR motor vehicle. There is a delinquent fee for fallme to do so. Adaoh Certificate of Title assigned by seller On en- DEALER PLATE NO. domed Tines, liens must be released. Supponing documents surrendered with Ihis application cannot be returned IQ the appri- cant.'In eccardance with Federal Code 383. TITLE NUMBER BRANCH NO. INVOICE NO BMV USE ONLY 'SOC. SECJFEDERAL I.O.NO. APPLICANT'S NAME 8MV USE ONLY 2. CARMEL CLAY PARKS RECREATION STREETADDRESS CITY STATE CODE 3. 1427 E 116 TH STREET CARMEL IN 46032 VEHICLE I.D. NUMBER VEH.YEAR VEH. MAKE VEH. MODEL NO. VEH TYPE ODOMETER 4. IFTYR.15F29PA28907 09 FOR R15 TRK 10 FORMER TITLE NUMBER PURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY 5 01/18/09 Y€�S 808M FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREETADDRESS 5. CASH CITY STATE ZIP CODE BMV USE ONLY 7 IN SECOND LIEN'S NAME STREETADDRESS I B. CITY STATE ZIP CODE LICENSE NUMBER LICENSE FORMS BMV USE ONLY 9 YEAR USED I GROSS RETAIL USE TAX AFFIDAVIT INVE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW. SELLING PRICE LESS TRADE -IN' AMOUNT SUBJECT TO TAX JAMOU14TOF TAX DEALER BRANCH EXEMPT IF EXEMPT 10. S Q c PACE PARA. 'Your Social Security number! Federal I.D. number is being requested by this agency under IC 4- 11 -8 -1. Disclosure is manadatory and this document cannot be processed without it. APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE a STATE OF INDIANA BUREAU OF MOTOR VEHICLES BUREAU TO BE MAILED WITH TITLE REPORT Form Indiana Department of Revenue ST -108E Certificate of Gross Retail or Use Tax State Form 48841 EXEMPTION for the Purchase of a Motor Vehicle or Watercraft NAME OF DEALER Dealer's RRMC (Registered Retail Merchant Certificate Number) PEARSON FORD, INC. I TID# (10 digits) LOC# 3 digits) Dogtjb� I r4deral Identification Number, 9 digits) 808M Ad�ks d I ale ICHIGAN RD. 'INDIANAPOLIS I State 'it� EL CLAY PARKS R NAME. EQ FRP ,ffHAShR(St},1PffT SSN, TID, OR FID (Mandatory) Addre�SS4Qf7Pt{rche TH STREET Cit State zip Code 11 LL tt CARMEL IN 46032 VIN (Vehicle Identification Number) or HIN It (Hull Identification Number) Year Make Model /Length IFTYRISE29PA28907 2009 FORD RANG Calculation Of Purchase Price Trade in Information 1. Total Purchase Price 1. 18S41-00 VIN (Vehicle Identification Number) or HIN If (Hull Identification Number) 2. Trade- Allowance (Like -kind exchanges only) 2. Year Make Model /Length 3. Net Purchase Price 18541.00 (Line 1 minus Line 2) 3. NEW RESIDENT STATEMENT Must Be Completed if Exemption 8 is claimed, see reverse side. I certify that I became a resident of INDIANA on (month year) My previous State of Residence was I hereby certify that the above statement is true and correct. Date Signature of Owner SALES /USE TAX WORKSHEET To be completed if Sales and /or Use Tax was paid to a state other than Indiana, Exemption 15. See reverse side. Date of Purchase 1. Purchase price of property subject to sales /use tax 1. 2. Indiana sales/use tax due: Multiply Line 1 by sales /use tax percentage (6 2. 3. Credit for sales tax previously paid, to another state ........................3. (Do not include flat fees, local, and /or excise taxes.) In what state was the tax paid? 4. Total amount due: Subtract Line 3 from Line 2 .............................4. (Line 3 can not exceed Line 2) DIRECT RELATIVE IDENTIFICATION EXEMPTION (Must Be Completed if Exemption 11 is claimed, see reverse side). Name(s) on original title Relationship of above parties Name(s) being added /deleted PUBLIC TRANSPORTATION EXEMPTION (Must be completed if exemption 6 is claimed and yo are not a school bus operator.) USDOT (U.S. Department of Transportation Number) I certig Bove vehicle or watercraft is exempt from sales /use tax under exemption (see reverse side). I also certify that any sales tax credit shown as paid to an out of state dealer using exemption #15 was actually collected by the dealer and the dealer has not provided the buyer with a check to be paid to the BMV. I understand that making a false statement on this form may constitute the crime of perjury. Date Signature of Purchaser GENERAL INFORMATION INDIANA CODE 6- 2.5 -9 -6 requires that a person titling a vehicle or watercraft present certification indicating the state gross sales and use tax has been paid; otherwise, the payment of the tax must be'made directly to a Bureau of Motor Vehicles license branch. If NONE of the exemptions apply to the purchase, Form ST -108 must be completed by the dealer and the purchaser to indicate that the sales /use tax was collected by the dealer. The dealer is then required to submit the sales /use tax to the Department of Revenue. The exemptions that are available are as follows: A purchaser's ID (SSN Social Security TID Indiana Taxpayer Identification FID Federal Identification is mandatory to claim the following exemptions. The exemption is not valid without one. Exemptions available are: i 1. Vehicles or watercraft purchased by Indiana or Federal governmental units or their instrumentalities. 2. Vehicles or watercraft purchased by nonprofit or`g'anizations operated exclusively for religious, charitable, or educational purposes and using the vehicle for the purpose for which such organization is exempt. The applicant MUST indicate its 13 digit Indiana TID and LOC number on the front of the form. The nonprofit name must be on the title to,c(afm this exemption. 3. Issue title for the sole purpose of adding lien holder information. This exemption is not available to add, delete, or change the name on a title. 4. Trucks, not to be licensed for highway use, and to be directly used in direct production of manufacturing, mining, refining or harvesting of agricultural commodities. Ready -mix concrete trucks are exempt under this paragraph even though they are to be licensed for highway use. Vehicles registered with farm afates are not exempt. 5. Sales of motor vehicles or watercraft to Registered Retail Merchants acquiring the vehicles or watercraft to rent, or lease to others and whose ordinary course of business is to rent or lease vehicles or watercraft to others. 6. Vehicles or watercraft to be preddminately used for hire in public transportation. (Hauling for hire) Your USDOT number must be shown on the reverse side of this form. Predominate use is greater than 50 7. Vehicles or watercraft transferred from one individual to another with no consideration involved or received as outright gift or inheritance. Assumption of loan payments by the purchaser constitutes consideration and is therefore NOT exempt unless the transferred party was listed on the original security agreement. A copy of the original security agreement must be submitted with the title paperwork. 8. Vehicles previously purchased, titled and licensed in another State or Country by a bonafide resident of that State or Country, who subsequently has become an Indiana resident, are exempt from Indiana sales /use tax upon titling and registration of the vehicle in Indiana. Watercraft previously purchased, titled, or licensed in another state, by a bonafide resident of that state, who subsequently has become an Indiana resident, are exempt from sales /use tax upon titling or registration of the watercraft in Indiana. The New Resident Statement on the front of the form MUST be completed. 9. Vehicles or watercraft purchased to be immediately placed into inventory for resale. Nonlndiana dealers must enter both their FID number and their state's Dealer License Number on this form in lieu of the Indiana TID number if they are not registered with the Indiana Department of Revenue. Note: Motor vehicle dealers are ;only exempt from sales tax bn new motor vehicles purchased for which they possess a manufacturer's franchise to sell that particular vehicle. If a dealer does not possess a manufacturer's franchise to sell the new vehicle purchased the dealer must pay sales tax and the resale exemption is invalid. (I.C. 6- 2.5 -5 -8) 10. Vehicles or watercraft, not to be licensed for use, which are eligible for a repossession title issued by the State of Indiana as a result of a bonafide credit transaction or salvage title resulting from an insurance settlement. 11. Transactions consisting of adding or deleting a spouse, child, grandparent, parent, or sibling of the owner of a motor vehicle only per 6 -2.5 -5 -15.5. The Direct Relative Identification Statement on the front of the form MUST be completed. 12. Vehicles or watercraft won as a prize in a raffle or drawing which were previously titled by a qualified nonprofit organization. A valid Federal Miscellaneous Income Statement, Form 1099 -MtSC or an affidavit completed by the nonprofit organization must be submitted with the title paperwork in order for this exemption to be claimed. The affidavits must state the nonprofit organization name and exemption number, the winner's name, address and social security number and the fair market value of the vehicle awarded as the prize. 13. Redemption of repossessed vehicles or watercraft by the original owner. 14. Indiana Department of Revenue use only. This exemption may not be used unless authorized by the Department by calling (317) 232 -2339. A complete copy of each transaction claiming this exemption must be sent to IDOR, Compliance Division. 15. Sales tax paid to a non -BMV licensed dealer. The seller may be either an Indiana seller or an out of state seller. This amount will be used as a nonrefundable credit against the amount of Indiana sales tax due. This agency is requesting the disclosure of your Social Security number in accordance with IC 4- 1 -8 -1. Disclosure is mandatory; this record cannot be processedwithout it. aa, C 3.. vr �{'�2�` trY ti. �d r ,.a' 4 r`, ��ly `x 2 a ..�i• �x 'fi e �.�5+"`�" ,��,/`31' P J <7 f "�,,h t 'r sJ r •,Y t r si"'' a .r t 1 u d F h' P4TE t osr rri fa t+ R a h y f INVOICE N0 >4 t i�OVEMBER 7'9 2Q08 Y 1FFTYR129,PA289o7� 2(709f FORDS? s 3 r S `a L f S f -a -F• ~fin }�•r t30D)PE1 a1P 1u�ff zy� "•f n bra` SbIfPPNVG WElG19T p 7 :26 `�RF,NGER,aSUPERCAB 2DRs�`4X4 d H'P {5 )i 6 V W R z E NO CYL$ SERIES OR -MODEL 5000 LBS 6� 1 n 115G e# ,�r?t NOMINAL TONNAGE t� 1 /2 t� v t '7 s a .1y �IXS`S r.ftE "44y T >r('"'Y ;�2tr �ti 'j 3 I i Y', w t y ct s '.I;the un�ersg+�e uthprrzed epresenfative of tl�e com #trrti`'or corpoiafron named below, herby! er Y trnrtsferrei3�on' the above date and under ttie invole Nu dl of d tope following. orporation and Is b dlstnbutor or cleaier �'�PearsonFord 1065f1�,13or:th Michigan Rrsed sf.: Mir u t 'onsv�Ile N;: X 5 4'6077 a Pty e fi' r �r rr w i 'r �y .,Ir e ,1 y _..'ti E� r� k l •EF' d; :�fF ,.IS,� 3,V Y4TY e. i .Ittis further certlfted +that this was the first iraeZSfer of¢such new motor vehicie In orcfrnaryrtrade and co'mmerte ri .hix y e its MEM DATA O O :G §i 'a. FINANCE�SOURCEt `000.001 y t n -'tom M. SY t n1 r FC3rCI MOtorr i CreC�lfttO (SIGNATUREOF�AUTH ED REPRESENTATIVE) i (AGEN 0 Dearborn r MI t Sr DEARB0RN MYCHIGAN t< 1 f T �..14 �C1TY SfiAiE ,,i X17!,1 I �n,N. .:I' i ?e- fv sA '0..- F_2lr: Sfi tt..Yi- .3M',rt>LO...i11� .P�:fi. i�•r.R. s�_ 4.,,.Yiu.>i�'. 5v. :ISeS y.S... kA.!?; :�_rx. ,�s?:�_eA ±!:r ^..:r .rtr v_... Gr.., -n,. ...i+. _k ii fio a,. n T c.r'+.;p a. r•tir C_ wcy x s' ;al.t .a.+i+'..E ie-. rx ,•1 t tb c. 'L untlersigned Belle certifies to�ha hest of his knowlac�e�j, Infom+at+onend belfei urWer partelty of law that the verucleis rcew and'•hes not t�ii`reglstor� in 'r A r this or ar�y state at t}te time of delivetyarxl the vefilde Is rtgt "sabred to,a`r_ry,seCffrlty,lriterestS kitlmitthan those; d#sgosed her6q acid Warrant bile the vehtcfe t`7 n X fflFt V E RE€iEiVFD f TRANSE R THEsVEhUGtE 1�ESCRItp ON THE FACE'OFTI 11S CEIiT1FlCATE'7p t a y 1# xs '?ryrt PEJ HASER(S) f^- J I ADORESS •'f 1 `7 i s x ,st �L st' �Ci Z i certrht to the hest of m o�wted tt,at the orrl to &r ead ����O 'J j a tF of o s UCFWE w 3MeaR t1 -beein u rn oath says hat the statements set as a State of 1 l}x ft N �Torth9 are a and co Sub and sw to r be tat 7 t F; Notary Public r 4 u$E NOTAF$ZAYYON OPItYtF F1tOI II 1iREb IN ttY11NG.IUrtlsDlCnoN 1 NAME OF tt N6 to theltesi of my knowled that th6od oet¢r«p NpT9rtths NAME y OFD SHIP DEAtER$ LICENSE NUMBER T Being duly SwOrh Upon Odtfi 5a that th statements set 1 51ste of r forth are true and conart Ssebsratbed and sworn to ri �4 A�i j beforetb t f dayof 20 PUN f .:b i'.x fi.4 a z a sS�L SE AR17AT YIF R6DIN TITCjNO PoSD! C�1t+n NAME`OF i v iei ';•w't p :KS a ..k r T r r It z YlrCertiflr to the: best of my know(edg the odometer re reading r No TenVts O EA E t`° R 'S `6: �i"` i5's t B r... ti t RSHIP _bEALER'S LtOENSE NUMB[81 .y Being,duly sworn upon bath saYYS ttYat Statements Set NA1l4E OF D ¢z Staisof �cl t at{1 forth Bro 7ueanfi¢orrect $ut5sctitedandswointome p z ''l•- before th is day of t 20i P. u' Corm d .li,,Yt ,fir y v y n L +sd ltr''C `a S�i{..1' -'va" -'t USE h10TAAIZATI0N:O1Vlt' AEOFJlFiED IN ^'X� NOrsO!y 1 JU tTTtJNO tt.`DON r U1 Pt1RCHASER( S} ,r .trtv 11 ?;ter AIJISAESS 4 Zr I v` �S',� S n F i r a'�'{7" Yeti C t 55c Wit I c l certify to4he� best of my ltngwled 'thettta odometerreadtn9 r f No Tenths }{k4 OF FSHIP� .PEALERS'UGEMSE N[1MI Being (t swrn o upop dtkth Says that the statements set 2 s k E t r forth are tru8 and carfect SubScrebed and swum iam¢ StatB o1 day iU9E NOTARtlATtOti OIdLY.IF AEiktBtm04 T T1 N6 lURISINGTfON ry PU61iC FrideraY aw L requ-Iras you to stata#Whoofneter rrlife aga n Conn- er.tltn iii i,the' transfor of ownership% Faslure to complete 6( prov[ding a f lsa statement may result"s W ,f- z m fees andlor impnsan tfettE r t t r TrS 9: 4i s a c s r G C t i cefhly to the test of my Imowiedge tat the odometer raadmg'Is the ectua mffeage of the vehicle ur> 6 one of the following statemens Is checked °Odomater i ;Reading Ter tfts LIXhe m M ge stated is axr 5s of iES memop irmds C1 The odometer reeding is.not the ats al txulaage j r WARMING ODQ�IETER OISCREPANCY�. Slgriature(s7 afSeller(s) r 'R.._ f yt r n r f Date bf Statement Data #5f Sale '..t•' Bgtrigdlfly Upo for oath says that the stdtem a, Pnrtfed Neme(sJ "of Seliers(s) a tbaiors I fo er th are true and oortectubsrn and arm's r T me rgnaturB(s) of PUnChaser (S) 't>efara thts day of 20 RnntettNam¢(s}'ot Purchaser(s) j j x r J NotaryPutxa G CornpaRyfdame.pi cablaj {7_S x y StatB 4PPI Address of Purchaser(s) r r Cou�n Ai C" h 115E til'}iARIZATION Bt+ILY:IF REDt1IR£D.IN ttTLING JURkSDtCT10N. 1, w 1 s1 lien In favot s of s e Y wfto'Se`addre5?s$ 'r:s" f., r! 3� 4 7�) a r j G Y i r ,a s;� rt r Yf .c T�. c .-c, t i x 8' Ls 5 2 2nd•hen m ht �r t�+ t. x ti., �r s 1 w k i �.je a ti.r ✓+sr Y .e xti� i s whse o address tr.V) .z. ":z.. ,n i •.c. ,s :�.,'"A d ;yam 1. ?Y'n'.;'t 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. Indiana Bureau of Motor Vehicles Terms 100 N Senate Ave Indianapolis, IN 46204 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 1129109 Ck request Purchase of title, plate for P09 15.00 Total 15.00 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, Indiana Bureau of Motor Vehicles Allowed 20 100 N Senate Ave Indianapolis, IN 46204 In Sum of 15.00 ON ACCOUNT OF APPROPRIATION FOR 101 -General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 Ck request 4351000 15.00 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 2 -Feb 2009 Signature 15.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund