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Home My WebLink About209957 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00351564 Page 1 of 1 ONE CIVIC SQUARE GARY CARTER CARMEL, INDIANA 46032 4748 BISHOPSGATE DR CHECK AMOUNT: $15.00 CARMEL IN 46032 CHECK NUMBER: 209957 CHECK DATE: 6/20/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4358300 15.00 OTHER FEES LICENSES �Y Bureau of Motor Vehicles I III) VIII II III IIIIIIIIII II IIII IIII II V III Customer Detailed Transaction Receipt BMA' State Form 51714 (4 -04) Branch: VEHICLE SERVICES REGISTRATIONS Date: 06/05/2012 Time: 16:04 EDT Visit ID: 176204139 CSR: LB Visit Customer: CITY OF CARMEL Transactions Trans ID Trans Tvge Trans Subtvr)e Amount 207497688 Title Initial Title Issuance New Title Fee Vehicle $15.00 Vehicle: 5JWTU2022C1061860 2012 SUR ST1 TR Lien Holder: None Customer: CITY OF CARMEL Purchase Date: 05/24/2012 $15.00 Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1 Bureau of Motor Vehicles k. s Customer Registration Fees Detailed Receipt �:BMV State Form 51718 (4 -04) Branch: V g E�HICLE SERVICES REGISTRATIONS Date: 06/05/2012 Time: 15:49 EDT 1T6� Visit ID: 04139 Tran ID: 207499268 Visit Customer: CITY OF CARMEL STARS Trans 06051280300037 Transaction Type: New Motor Vehicle Registration Registration License Type: MUNICIPAL OWNED Plate \Permit \Registration Number: Vehicle Identification Number: 5JWTU2022C1061860 Vehicle Year: 2012 Vehicle Make: SUR TRAC Vehicle Model: ST102164DO2A -B -140 Registration Year Fee Type Subtotal Total 2011 NONE (NONE) 2011 $0.00 CITY OF CARMEL Total NONE (NONE) 2011: $0.00 Organ Donation $0.00 Total for 2011: 0.00 Transaction Total: 0.00 Charges to your credit card will appear as a line item charge not as a total transaction charge. Page 1 of 1 State Form 48099 1-1 Approved byStae Board of INDIANA CERTIFICATE OF VEHICLE REGISTRATION Accounts 2010 CLASS I AGE ISSUE DATE IPUR DATE COUNTY TP PL YR PLATE PL TP WEIGHT I PR YR I LS I TYPE 06/05/2012 05/24/2012 29 -HAMILTON N 2011 MO N EXPIRATION DATE PRIOR PLATE VEHICLE YEAR MAKE TYPE MODEL COLOR VEHICLE IDENTIFICATION NUMBER NO EXP 2012 1 SUR TR ST1 BLK/ 5JWTU2022C1061860 CURRENT EX TAX EX CREDIT DAV CREDIT EX TAX DUE WHEEUSUR STATE REG FEE ADMIN FEE TOTAL DUE YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 PRIOR EX TAX EX CREDIT DAV CREDIT EX TAX Duq WHEEUSUR STATE REG FEE ADMIN FEE TOTAL DUE YEAR TAX 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 CITY OF CARMEL N 1 CIVIC SQ LB CARMEWN 460322584 IMPORTANT: REGISTRATION MUST BE SIGNED TO BE VALID I swear or affirm under penalty of perjury that the information contained in this form is correct. I swear or affirm that proof of financial responsibility (insurance) for this vehicle will be continuously maintained during the registration period. I understand that the vehicle's registration is not valid until the Bureau receives the total amount owed. Additional taxes and /or fees may be due if an error or an adjustment to the amount due is made. Vehicle Registrant Signature(s) (All vehicle registrants must sign in ink to be valid) X CUSTOMER COPY APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES State Form 205 (R7 6 -04) Approved by State Board of Account 1997 TO BE COMPLETED BY A POLICE OFFICER, BMV OFFICIAL OR BMV CERTIFIED DEALER SIGNEE I/WE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA- FOR OUT OF STATE TITLES. I HEREBY CERTIFY THAT I PERSONALLY EXAMINED THE FOLLOWING TION ENTERED ON THIS FORM IS CORRECT. I/WE UNDERSTAND VEHICLE AND FIN THE IDE NTIFICA TION NUMBE T BE AS F OLLOW S. THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI- VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE, IME AGREE TO INDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANY LIABILITY ARISING FROM THIS TRANSACTION. R MAKE MODEL TYPE DATE X X INSPECTOR'S PRINTED NAME TITLE CITY DATE: INSPECTOR'S SIGNATURE BA Bf�AN H R The law requires that you apply for Certificate of Title within thirty -one da rom the date of purchase of a motor vehicle. There is a delinquent fee of $21.00 for failure to do so. Attach Certificate of Title assigned by seller. On ery DEALER PLATE NO. domed Titles, liens must be released. Supporting documents surrendered with this application cannot be returned to the app& cant. State fee for applying for Title isw.00.'in accordance with Federal Code 383. TITLE NUMBER BRANCH NO INVOICE NO BMV USE ONLY 1. 06051280300012 803 MV- GOVERNMENT CERTIFICATE OF ORIGIN *SOC. SEC. /FEDERAL I.D. NO APPLICANT'S NAME BMV USE ONLY D 2. CITY OF CARMEL O STREET ADDRESS CITY STATE ZIP CODE N 3. ONE CIVIC SQUARE CARMEL IN 46032 0 I T VEHICLE I.D. NUMBER VEH. YEAR :EH. MAKE VEH. MODEL NO. VEH. TYPE ODOMETER EXEMPT 4. 5JWTU2022C1061860 2012 SUR ST1 TR 0 M T FORMER TITLE NUMBER PURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y P 5. C OF O 05 5 No No Yes E FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS 6. CITY OF CARMEL 2 CIVIC SQ N CITY STATE ZIP CODE BMV USE ONLY 7 CARMEL IN 46032 -2584 T H SECOND LIEN'S NAME STREET ADDRESS I 8. S CITY STATE ZIP CODE 7 LICENSE NUMBER LICENSE FORMS BMV USE ONLY A 9 YEAR USED R LB E GROSS RE TAIL USE TAX AFFIDAVIT I/WE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW A SELLING PRICE L DISCOUNT AMOUNT SUBJECT TO TA T OF TAX DEALER AMOUN BRANCH EXEMPT IF EXEMPT 10 0.00 0.00 0.00 0.00 X PLACE 1 ARA.# Your Social Security number/ Federal I.D. number is being requested by this agency under IC 4- 1-8 -1. Disclosure is mandatory and this document cannot be processed without it. APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATION APPLICATION FOR CERTIFICATE OF TITLE STATE OF INDIANA BUREAU OF MOTOR VEHICLES II VIII VIII III IIIIIIIIIIIII VIII IIIII VIIIVIIIVIIIIII 2 0 5 2 0 7 4 9 7 6 8 9 CUSTOMER COPY 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)) New Trailer $15.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Gary Carter IN SUM OF $15.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I I 43- 583.00 I $15.00 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 JUN 18 2W M t v U .e Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund