HomeMy WebLinkAbout209957 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