HomeMy WebLinkAbout180118 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 129401 Page 1 of 1
j ONE CIVIC SQUARE MICHAEL HOLLIBAUGH
CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK AMOUNT: 18011 7
CHECK NUMBER: 180118
<ION 00
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4351100 240.00 CAR CLEANING
1192 4355300 105.57 ORGANIZATION MEMBER
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Midwest Academy
801 Congressional Blvd
Carmel, IN 46032
ADEMY"
t DwEST 397- 8439500 4 Office
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317- 843 -2833 Fax
www,midwestacademyofindiana.org
Donor Information: Ite_m,#
Name: tC �c�. C. i I Y:�{.�tGyt'� 1 W)
Address:
City, State, Zip: C �^•lfV'r by
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Online Llcensing
This page serves as your receipt for this transaction. Your payment will appear on your credit card
statement as "HEALTH /PROF LIC BUREAU To maintain this page for your records, you may print this
page by clicking the "Print Receipt" button below.
What to do next?
Renewal
Check back on the MyLicense site in 24 48 hours to see if your expiration date was extended. If
not, this may mean there is a problem with your renewal application and you will be contacted.
e If you answered "Yes" to any of the disciplinary questions, you must provide additional information
before your renewal can be processed. You may still work with your current license for up to 90 days
while your renewal is being reviewed by the board.
When your license was issued or last renewed, you received a permanent license card one will
not be generated from this renewal (except for CSR). Duplicate or replacement license cards can be
purchased by returning to the licensing home page.
Payment received thank you.
Licensee: Michael P. Hollibaugh
License Number: LA29300015
Authorization Code: 27633A
Received Date: 12/1/2009 1:45:16 PM
Transaction ID: 4997873
Credit Card Number: XXXX XXXX XXXX 0014
Fee Amount: $100.00
Enhanced Fee: $2.50
Instant Fee: $3.07
Total Payment: $105.57
Renew Another License
Louout
Indiana Professional Licensing Agency We work to
Architects Landscape Architects Board keep you working
402 W. Washington St. Room W072
Indianapolis, IN 46204 r[P L A
Professional Licensing Agency
Michael P. Hollibaugh
City of Carmel DOCD
1 Civic Square
Carmel IN 46032
Renewal Information Notice
License LA29300015
Expire Date /Status: 12/01/2009 Active
Web Login ID: LA29300015
Web Password: Social Security Number without Dashes
Your Landscape Architect license will soon be expiring. Your renewal can now be processed online. Online renewal
is faster and more accurate.
Renew online 24 hours a day, 7 days a week. It only takes a few minutes and is QUICK EASY.
By using the online renewal, your renewed license is posted within one business day.
Renew at www.pla.in.gov and select the License Express link. Your Login information is above.
You can use your Discover, Mastercard, or Visa credit card or debit card.
You may update your address, email, phone numbers during the online renewal process.
The fee to renew your Landscape Architect license is $105.57. This includes the $100 renewal fee and
credit card processing fees.
If you have questions about the renewal, contact the Board of Registration for Architects and Landscape Architects by
email at Pla10(@pla.in.gov
Pocket Cards The Indiana Professional Licensing Agency no longer issues pocket license cards at license renewal.
If you need to purchase a new pocket card, you may do so online at www.pla.in.gov select the License Express link
from the PLA home page (pocket cards can only be purchased online). Please note that permanent pocket license
cards no longer contain expiration dates, although a card with an expiration date is also available for purchase online.
Late Fees if you apply for renewal of your license after December 1, 2009, you will be assessed a $50.00 late fee for
each expired renewal, in addition to the standard renewal fees. There are no exceptions if you renew late, you
must pay the late renewal fee in order to renew your expired license.
IMPORTANT ADDITIONAL INFORMATION REGARDING YOUR PROFESSION:
THIS IS A NOTIFICATION ONLY AND NOT AN OFFICIAL RENEWAL FORM. DO NOT SEND A CHECK OR MONEY
ORDER WITH THIS FORM or BY ITSELF.
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/01/09 4997873 Landscape Architect License $105.57
12/04/09 Mike's Car Wash Certificates $240.00
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 N WARRANT NO.
ALLOWED 20
Michael Hollibaugh
IN SUM OF
c/o One Civic Square
Carmel, IN 46032
$345.57
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1192 4997873 43- 553.00 $105.57 1 hereby certify that the attached invoice(s), or
1192 43- 511.00 $240.00
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
Monday, Decemberr67, 2009
[Vector, D S
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund