210714 07/16/2012 CITY OF CARMEL, INDIANA VENDOR: 355377 Page 1 of 1
ONE CIVIC SQUARE LOIS FINE CHECK AMOUNT: $6.12
CARMEL, INDIANA 46032 10680 MORRISTOWN COURT
CARMEL IN 46032 CHECK NUMBER: 210714
CHECK DATE: 7/16/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4347500 6 . 12 NOTARY FEE
Indiana Payment Portal Page 1 of 1
Your transaction is complete
Your transaction is complete. Print this receipt for your records. Your receipt
identification number is 3225685. Please reference this number in any
correspondence regardi ng your transaction.
Payer Information
LOIS FINE
10680 MORRISTOWN COURT
CARMEL, IN 46032
;Phone : 317 - 873 - 6355
Email : Ifine @carmel.in.gov
Account Information ?
5***********8962 exp. 07/14
Transaction Details
Unit Extended
Description Price Quantity Price
,Notary Application Fee $5.00 1 $5.00!
.Instant Access Fee $1.12 1 $1.121
Total : $6.121
The following amounts have been charged to your credit card. Your credit card
statement will show the following merchant name(s) a nd amount(s) for this
transaction.
Merchant Amount
i
IN Sec of State 800-236-5446 $6.12;
The total amount charged to your credit card is $6.12.
Privacy Statement
https://secure.in.gov/apps/kwikekard/checkout/servlet/receipt?token=C4B74... 7/13/2012
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2
Total
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.
ALLOWED 20
IN M
SU OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund