167553 01/06/2009 CITY OF CARMEL, INDIANA VENDOR: 360614 Page 1 of 1
ONE CIVIC SQUARE BUREAU OF MOTOR VEHICLES
CARMEL, INDIANA 46032 309 w SOUTH STREET CHECK AMOUNT: $205.05
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WINCHESTER IN 47394 -2029 CHECK NUMBER: 167553
CHECK DATE: 1!6!2009
DE PARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1160 4352600 205,05 AUTOMOBILE LEASE
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as I State of Indiana
Bureau of N/101101' Vehicles
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100 N. Scnate Avenue [Zoom N440
Indianapolis, IN 46204
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Expiration Date 1/31/2009
hIM expiration date
BMV service options: Renew online and save $5, mail -in
payment, use an SST, or visit any license branch or BMV
11125/0313'50 000964020081218DLF5610313MVVEHIIOZDOMDLF661D000 '156927 VH service partner. Learn more atwww.myBMV.IN.gov
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FORD MOTOR COMPANY tF
1 CIVIC SQUARE
CARMEL, IN 46032 -2584
RENEW BY MAIL IIIIII
DIRECTI
Step 1 Confirm that you are the person(s), company, partnership or entity listed on this form(s). If you are not, disregard the notice.
Step 2 Confirm that you own the vehicle, watercraft and /or trailer listed below. If you do not, you may disregard the notice.
Step 3 Add a $5.00 late fee to each FEE TOTAL if payment is made after the expiration date listed above.
Step 4 Would you like to contribute $1.00 or more to educate Hoosiers about organ and tissue donation? Please enter the amount below.
Step 5 To obtain the TOTAL DUE below, add the fee total, late fee and orgafi donation amoulits.
Step 6 For vehicle renewals, you MUST verify the INSURANCE INFORMATION enclosed in order to have your renewal processed.
Step 7 If you are paying by CREDIT CARD (Visa or MC only), please complete the back of the form and sign it. Your credit card will be charged for all
renewals submitted (including any applicable late fees) unless otherwise specified.
Step 8 Renew by 01/16/09 to receive your completed registrations(s), plate(s) and /or sticker(s) prior to your expiration. If you have followed these steps but
do not receive your registration(s), plates(s) and /or sticker(s) prior to your expiration date, please call (317) 233 -6000.
APPLICATION FOR VEHICLE REGISTRATION RENEWAL TOTAL DUE
FEES AND TAXES (NOT INCLUDING DONATION)
STATE PL I SPECIAL PL I GRP PL I ADMIN I COUNTY EXCISE I EXCISE CUT SURIWHEEL I PLATE NUMBER
#1 21.05 0.00 0.00 0.00 367.00 183.00 0.00 187GAB $205.05
TOTAL FOR $205.05
ALL REGISTRATIONS
For information about changes to your mailing address, please see the back of this form.
IDetach and mail forms with vour oavment and retain this ton oortlon for vour records .I
Attention
Please be sure to note your expiration dale and renew on time to avoid paying a $5.00 late fee.
Proof of Financial Responsibility r i r•
x_
Indiana law prohibits any person from operating a motor vehicle in Indiana if financial responsibility is not in effect. Proof of financial responsibility
includes one of the following:
1. Motor Vehicle insurance policy
2. Indiana Motor Carrier Association number (IMCA number)
Vehicle Registration
Explanation of Fees
1. Registration Fee- This is the fee for registering your vehicle. $6.25 is distributed to the Bureau of Motor Vehicle Commission to cover the
expenses of operating the license branch. The remainder is distributed to Stale Highway funds and used by the state and counties for road
construction and repair projects.
2. Special Plate Fee- This fee is charged for the administration of the special plates program at the license branches and the Bureau of Motor
Vehicles' main office.
3. Group Plate Fee- This fee is charged on various special recognition group plates. The fee for the Heritage Trust plate and the Children's Trust
Fund plate is issued to benefit those charities. Seventy -five percent (75 of the fee for the Education plate is directed to the school district of
your choice. The remainder goes to the fund used to develop counseling programs at schools throughout the state.
4. Administrative Fee- Processing and handling fee.
5. County Excise Tax Tax on certain vehicles based on the value of the vehicle when it was first offered for sale in Indiana. The Bureau of Motor
Vehicles Commission receives $1.15 for the collection of any excise tax amount. The remainder is distributed to your county of residence.
6. Tax Cut The reduction in Excise Tax enacted during the 1996 legislative session.
7. Sur /Wheel Tax Sur tax and Wheel tax are optional county taxes that may be enacted by any county. Sur Tax is either a flat rate or is
figured as a percentage of the Motor Vehicle Excise Tax before any credits or reductions are taken. Wheel Tax is a flat fee based on the
vehicle type. If your county has enacted these taxes, you will pay Sur Tax or Wheel Tax not both.
8. Total This is the amount due to renew your vehicle's registration. It is the sum of 1 through 7.
9. Anatomical Gift Donations- (optional) you may make a donation to organizations that promote the procurement for anatomical gifts.
The money from this donation is set aside in a fund for distribution to these organizations.
Check your mailing address. If incorrect, please enter the correct mailing address below. If your name has changed or you have moved to a
different county, you must contact a branch to make a change. Check the "address applies to all registrations" box below, if applicable.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
.4" 'r CITY OF CARMEL
1/5/09
�An invoice or 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
Bureau of Motor Vehicles Purchase Order No.
309 W. South St. Terms
Winchester In 47394 -2029 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/09 Stmt Renew license plate for Mayor's vehicle $205.05
Total $205.05
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.
T ALLOWED 20
Bureau of Motor Vehicles es IN SUM OF
�r
309 W. South St.
Winchester IN 47394 -2029
205.05
ON ACCOUNT OF APPROPRIATION FOR
1160 Mayor 4352600
Auto Lease
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
st-mt 4152600 $205.0 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
20
i nature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund