HomeMy WebLinkAbout205889 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 146900 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF ENVIRONMENTAL M T
CARMEL INDIANA 46032 CASHIER OFFICE MAIL CODE 50 -10C HECK AMOUNT: $100.00
100 N SENATE AVE
CHECK NUMBER: 205889
INDIANAPOLIS IN 46204
CHECK DATE: 1/3112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4358300 149397 100.00 OTHER FEES LICENSES
INVOICE
Please Remit To: Page: 1
INDIANA DEPT OF ENVIRONMENTAL MGMT Invoice No: 000149397
CASHIER OFFICE MAIL CODE 50 -10C Invoice Date: 01/09/2012
100 NORTH SENATE AVENUE Customer Number: CST100026885
INDIANAPOLIS IN 46204 Bill Type: 062
Payment Terms: NET 60
Due Date: 03/09/2012
Bill To:
CARMEL CLAY PARKS RECREATION
MS AUDREY KOSTRZEWA- FLOWING WELL AMOUNT DUE: 100.00 USD
1411 EAST 116TH STREET
CARMEL IN 46032
Amount Remitted
F] Note Address Changes Above
For billing questions, lease call 317 232 -8705
Line Ad' Identifier Description Quantity UOM Unit Amt Net Amount
1 12- IN2290801T -0 PWS Fee GW 1.00 EA 100.00 100.00
This annual fee billing is required for active Public Water Systems (to defray the costs of
administering activities of the federal Safe Drinking Water Act) under Indiana Code: IC 13 -18 -20.5.
To view via the internet, visit:
http: /www.IN.gov/ legislative /ic /code /titlel3 /arl8 /ch2O.5.html
Fees are based on the activity status as of December 31 of the previous year.
Fees on Transient Non Community Water System will be based on the type of water system on record
by December 31 of the prior year.
Fees are not pro- rated. If a system is sold or inactivated during the billing year, the amount of
the assessed fee remains due and payable.
If payment of the assessed fee amount imposes an undue burden on the public water system, the
facility may notify this Agency within forty -five (45) days of this invoice date to pay in four
equal installments within a year.
Payments not received or received after the DUE date are subject to a delinquency charge equal to
10% of the assessed fee.
If several invoices are to be paid by one check, you MUST INCLUDE A COPY OF EACH BILLING INVOICE
in order to ensure proper credit for each fee assessment.
For questions regarding your assessed fee amount, please contact Deborah Glover in the Operations
Section, Office of Water Quality at 317 232 -8472.
ATTENTION: The due date shown in the upper right hand corner of this invoice reflects the
standard 60 days past the invoice print date.
TOTAL AMOUNT DUE: 100.00
A copy of your invoice must be included with payment.
Purchase F (Id 0�tA L_
Description Onnr;(.0Q
P.O.# u PorF
G.L. /I.�75
Budget Line Descr JAN 1 2 2012
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Purchaser Date
Approval /Cp Date
495 -IDEM Printed on Recycled Paper Original
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.
146900 Indiana Department of Environmental Mgmt Terms
Cashier Office Mail Code 50 -10C
100 North Senate Ave
Indianapolis, IN 46204 -2251
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
119112 149397 Annual permit for public water Flowing Well 100.00
Total 100.00
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.
146900 Indiana Department of Environmental Mgmt Allowed 20
Cashier Office Mail Code 50 -10C
100 North Senate Ave
Indianapolis, IN 46204 -2251 In Sum of
100.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #[TITLE AMOUNT Board Members
Dept
1125 149397 4358300 100.00 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
26 -Jan 2012
Signature
100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund