209977 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
0 ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURI�y
CARMEL, INDIANA 46032 BOILER AND PRESSURE VESSEL DIVISIO CHECK AMOUNT: $25.00
302 W WASHINGTON ST RM 246 CHECK NUMBER: 209977
INDIANAPOLIS IN 46204 -2739
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 222698 25.00 TRANSPORTATION EXPENS
INVOICE FOR INSPECTION CERTIFICATE FEES
=o State Form 356 (R4 9 -93)
Approved by the State Board of Accounts 1991
Division of Fire and Building Safety
�eW 1. Mail checks payable to DEPARTMENT OF HOMELAND SECURITY You can pay all your payments online at IDHS web site
2. Mail 2nd copy check to DEPARTMENT OF HOMELAND SECURITY https: l/ myoracle. in. gov /dfbsriidhsFeesFines /start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card /Discover cards. Use Owner don
302 W WASHINGTON ST., RM 246 this letter or Indiana State Number on the invoice to pull
INDIANAPOLIS IN 46204 -2739 up information when paying the dues online.
Telephone: (317) 232-1921
i INDIANA STATE
NUMBER CARMEL CITY OF LATEST PLEASE
CE PAY THIS
222698 C/O LISA KEMPA
INVOICE
AMOUNT!
Owner Id 760 3RD AVE SW SUITE 110
651680 CARMEL, IN 46032 05/30/2012
Owner number User Name Location of vessel POLICE DEPT Fee
3 CIVIC SQ 25.00
CARMEL IN 46032
Serial number I Description of vessel Manufacturer Da Last Inspec
AIR RECEIVER WOOD IND 05/04/2012
National Board No. Inspection agency Name of inspector (This fee is
557840 TRAVELERS CALHOUN JOSEPH S prescribed by
�IL 6751AC 12 -3 -13)
Inspection Date Inspector Name Inspection Type Due
05/04/2012 CALHOUN JOSEPH S RE- INSPECTION -U- 222698,05/30/2012 25.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
362497
DEPARTMENT OF HOMELAND SECURITY Purchase Order No.
BOILER AND PRESSURE VESSEL SAFETY DI% Terms
302 W WASHINGTON ST RM 246 Due Date 6/6/2012
INDIANAPOLIS, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/6/2012 222698 $25.00
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
6 l v C,--X in..
Date Officer
VOUCHER 125076 WARRANT ALLOWED
362497 IN SUM OF
DEPARTMENT OF HOMELAND SECUF
BOILER AND PRESSURE VESSEL SAF
302 W WASHINGTON ST RM 246
INDIANAPOLIS, IN 46204
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
222698 01- 7502 -06 $25.00
Voucher Total $25.00
Cost distribution ledger classification if
claim paid under vehicle highway fund