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Home My WebLink About207102 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 4 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY- FISCAL OFFI HECK AMOUNT: $360.00 302 W WASHINGTON ST, RM E221 CHECK NUMBER: 207102 INDIANAPOLIS IN 46204 CHECK DATE: 3/13/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4350100 120.00 7675 03012012 -1 1205 4351501 120.00 7675 02292012 -1 1205 4351501 120.00 7675 03012012 -1 c- W ff xis.. 4. r. 11VU Lr 1'r: ilk 1 CARMEL PUBLIC WORKS SAFETY ONE CIVIC SQ CARMEL IN 46032 1.If Code An annual test report is due before a permit is issued. 2.If Code A 5 year Test report is due before a germit is issued. 3.0ver due fees must be paid before a permit is issued. If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. State No Due Over Due Location Address 45583 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032 CBy--- Reference Number Invoice Date Please submit ENTIRE document with payment 7675 02292012 -1 02/29/2012 Unit(s) 1 Total Due upon receipt of 1 120.00 of 120.00 Owner Id 7675 Ref.Num.:7675- 02292012 -1 $120 of 120.00 Invoice Date 02/29/2012 If Paying by check, include a check made payable to the Department of Homeland security. You can pay all your payments online at IDRS web site httpo: /myoracle .in.gov /dfbs /idhsFeesFines /start.do with Visa /Master Card /Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when paying the dues online.OR complete the following information and return by mail :Indiana Department of Homeland Security, Fiscal Department, 302 W.Washington St., Rm E221,Indianapolis, IN 46204 or fax to (317)233 -0401. Questions? call(317)232 -6427 or E- mail :elevator invoice @dhs.in.gov 2.25% convenience fee charged on all credit card payments. Full Name on Credit Card Billing Address: Street City State Zip Code CC type:Am.Express /Discover /Master Card ONLY (circle one) (VISA payment online only) Acct. Number Exp.Date (mm /yy) CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's Agreement with the issuer. •r w �,.rt 'mil', 1 n it• y s 1 1 1 1 1 C 1 G•fr:.aTaCyTr. t •1 1 •1 t.`�"i l' -r r t•r•r HI .Ir 1 t ^Crc tK si i e L. i`APP: J�.�+ L L. L ],f.', Y 0'J. 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If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. State No Due Over Due Location Address 45581 $120.00 0.00 3 CIVIC SQ, CARMEL IN 46032 1110 45582 $120.00 0.00 1 CIVIC SQ, CARMEL IN 46032 I ZtzS T u )3 D Q MAR 12 2012 By Reference Number Invoice Date Please submit ENTIRE document with payment 7675 03012012 -1 03/01/2012 Unit(s) 2 Total Due upon receipt of 2 240.00 of 240.00 Owner Id 7675 Ref.Num.:7675 03012012 1 $240 of 240.00 Invoice Date 03/01/2012 If Paying by check, include a check made payable to the Department of Homeland security. You can pay all youx payments online at IDHS web site https: myoracle. in. gov /dfbs /idhsFeesFines /start.do with visa /Master Card /Discover cards. Use Owner Id on this letter or State Number on the invoice to pull up information when paying the dues online.OR complete the following information and return by mail :Indiana Department of Homeland Security, Fiscal Department, 302 W.Washington St., Rm E221,Indianapolis, IN 46204 or fax to (317)233 -0401. Questions? call(317)232 -6427 or E -mail :elevator invoice @dhs.in.gov 2.25% convenience fee charged on all credit card payments. Full Name on Credit Card Billing Address: Street City State Zip Code CC type:Am.Express /Discover /Master Card ONLY (circle one) (VISA payment online only) Acct. 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Oa 't1� b11� t>a b /I. �t•�' -y.� 7 7�_ It�: S' v f��_ S,.. 5,..�'.., J• :�'..�a� "I ref 1 `Fw 1 .��Q 1 Y!'c w 1L' Si►y L_u Sr_ 'Y -T l Y -1 Y Y -1�. 1 Y'tl�... l Y -1 ti Y -1.2: >L Y 1' „S 1 -a1� -1 '�r: '"�b •�`b y.•�b U�'��; •,••�b`�-�k-= Id �•�i 1d �•�Pib y .c -w1 t... "1:•' lam. u t (r" et t j �w t-'r t� t...•v.y x.. t.+". r t t.� t... �t•if1 t4•' LM •�.•.s! l. �•AJ (r' 1. "•[•E� VOUCHER NO. WARRANT NO. ALLOWED 20 IN Department of Homeland Security Fiscal Department IN SUM OF 302 W. Washington St., Rm E221 Indianapolis, IN 46204 $360.00 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1205 7675- 02292012 -1 43- 515.01 $120.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the l 1 0 7675- 03012012 -1 43- 501.00 $120.00 materials or services itemized thereon for 1205 7675- 03012012 -1 43- 515.01 1 $120.00 which charge is made were ordered and received except Monday, March 12, 2012 r Director, Administratio Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 02/29112 7675 02292012 -1 ADMIN 45583 $120.00 03/01/12 7675- 03012012 -1 POLICE 45581 $120.00 03/01/12 1 7675 03012012 -1 ADMIN 45582 $120.00 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