206701 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1
ONE CIVIC SQUARE I N S C C U -ASFE
CARMEL, INDIANA 46032 PO BOX 6271 CHECK AMOUNT: $55.00
INDIANAPOLIS IN 46206 -6271 CHECK NUMBER: 206701
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 0003454074 55.00 29D01- 9810 -DR -0614
Mitchell E. Daniels, Jr., Governor
1 James W. Payne, Director
Indiana Department of Child Services
Child Support Bureau
4 02 W. VVashington St., MS 11
n6a,napolls, Indiana 4604 -2/39
r
317 233 -54 �7
AX: 31 7- 233 -4925
www.in.gov /dcs
Child Support Hotline: 800 -840 -8757
02/18/2012 Child Abuse and Neglect Hotline: 800 -800 -5556
ANNUAL SUPPORT FEE NOTICE
The Indiana General Assembly set the amount of the Annual Support fee at $55.00, effective January 1, 2008.
Employers please dote: In instances where the Child Support Bureau does not have the address of the non custodial
parent (NCP), this notice is sent in the care of the NCP's last known employer. Employers are asked to forward this notice
to your employee, or inform the Child Support Bureau if the non custodial parent is no longer employed with your company.
Dear AARON HOOVER,
This notice is to inform you that pursuant to IC 33- 37 -5 -6 and IC 31- 16 -15, the 2012 Annual Support and Maintenance
Docket Fee (ASFE) for the listed child support case(s) shown below is due by 06/30/2012. The $55.00 fee is due for each
and every individual case. In order to assure proper credit, you must include the coupon on the second page of this notice
with your payment. In addition please remember to write on your check or money order the ISETS case number(s) listed on
the coupon and clearly note that the payment is for the ASFE.
DO NOT COMBINE your ASFE payment with a child support payment or you may not receive proper credit for the
payment of this fee. This is the only notice you will receive for this year's fee, this calendar year. If the total amount shown
is not received by 06/30/2012 an Income Withholding Order ,411 be sent to your employer to withhold the balance owed for
the current year's fee for each and every individual case eligible for income withholding. If you have any questions about this
notice, please contact the Kids Line at (317)233 -5437 or (800)840 -8757.
Please note: you may also receive an ASFE notice from your County Clerk's office regarding any past due ASFE balances
from previous years. Please contact the County Clerk about those notices.
Thank you
Indiana State Child Support Bureau
Department of Child Services
-c YLEnsl I3L'1'tiCll li�f1J7Rl 7OIIN� A F
PAYMENT COUPON
Mail this coupon with your check or money Date: 02/18/2012
order and make payment payable to: Name: AARON HOOVER
INSCCU ASFE MPI 0003454066
P O Box 6271
Indianapolis IN 46206 -6271
Please write on your check or money order the ISETS case number(s) and clearly note that the payment is for the ASFE.
Please, DO NOT send cash.
COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT
29D01 9810 DR 0614 0003454074 $55.00
Total ASFE Due for the above listed cases $55.00
RETURN THIS PORTION WITH YOUR PAYMENT
#BWNNXZL
#0003 4540 66C#
AARON HOOVER
C/O CITY OF CARMEL
ONE CIVIC SQUARE
ATTN KAREN HUFFMAN
ARMEL IN 46032
PLEASE RETAIN THIS PAGE FOR YOUR RECORDS
COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT
29D01.- 9810 -DR- 0614. 0003454074 $55.00
Total ASFE Due for the above listed cases $55.00
a
Protectiri our children fwwilier and fiitnre
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
S -s Purchase Order No.
7/ Terms
j 4 4 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
d
y
Total 'v
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.
Z-237
ALLOWED 20
/M S CC 6� 1-9`51&- IN SUM OF
6,,-? 7/
ON ACCOUNT OF APPROPRIATION FOR
2-37 Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
/o/ DOp3S�S�rj ��3 %%G� 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
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Ignature
Cost distribution ledger classifi Title
cation if
claim paid motor vehicle highway fund