212538 09/12/2012 a 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: 212538
«ON�
CHECK DATE: 9/1212012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4358300 15 . 00 OTHER FEES & LICENSES
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Bureau of Motor Vehicles
Customer Transaction Receipt IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII)
BIY State Form 51717 (4-04)
Branch: VEHICLE SERVICES- REGISTRATIONS Date: 9/4/12 Time: 7:55:37 am EDT
Visit ID: (178618288 Your Visit Time Today:
Visit Customer: CITY OF CARMEL
Transaction Time 00:03:21
Total time
Hrs.Min.Sec 00:03:21
Transactions
Trans ID (PIN) Trans Type Trans Subtype Amount
211315212 Title- Initial Title Issuance New $15.00
211315222 Registration - New Motor Vehicle Registration New $0.00
Subtotal: $15.00
Sales/Use Tax: $0.00
Total: $15.00
Payment Method Amount Authorization Number Name
CREDIT $15.00 06063B
Total Due: $15.00
Amount Paid: $15.00
Change Due: $0.00
Within 10 business days, you will receive your registration or title through the United States mail. You will be able to track the
progress of your registration or title by using your PIN number listed above when calling the BMV Customer Service Center at
888-myBMV-411 (888-692-6841).
If you have questions or comments, please call our Customer Service Center at 888-myBMV-411.
Please help us improve our service by completing a one-minute customer satisfaction survey. Your responses are completely
confidential. Visit http://www.in.gov/bmvsurvey/start and enter the survey code 178618288 to get started. Thank you.
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5 1 7 1 7 2 1 1 3 1 5 2 2 2
s Bureau of Motor Vehicles IIII III II II III II VIII III III IIII IIIIIIIIIIII
.f Customer Detailed Transaction Receipt
IR State Form 51714 (4-04)
Branch: VEHICLE SERVICES- REGISTRATIONS Date: 09/04/2012 Time: 7:55 EDT
Visit ID: ('178618288 CSR: SL
Visit Customer: CITY OF CARMEL
Transactions
Trans ID Trans Tvge Trans Subtype Amount
211315212 Title - Initial Title Issuance New
Title Fee -Vehicle $15.00
Vehicle: 1 FTFW1 ET3CFD01817 2012 FOR F1 S CW
Lien Holder: None
Customer: CITY OF CARMEL
Purchase Date: 08/24/2012
$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
sx Customer Registration Fees Detailed Receipt
BMV State Form 51718 (4-04)
Branch: (VgE�H31ICLE SERVICES- REGISTRATIONS Date: 09/04/2012 Time: 7:52 EDT
Visit ID: '178618288 Tran ID: 211315222
Visit Customer: CITY OF CARMEL STARS Trans#: 09041280300015
Transaction Type: New Motor Vehicle Registration
Registration License Type: MUNICIPAL OWNED
Plate\Permit\Registration Number:
Vehicle Identification Number: 1 FTFW1 ET3CFD01817
Vehicle Year: 2012
Vehicle Make: FORD
Vehicle Model: F150 SUPERCREW
Registration Year Fee Type Subtotal Total
2012
Total for 2012:
2011
NONE (NONE) 2011 $0.00
CITY OF CARMEL
Total NONE(NONE) 2011: $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
e'•'m�4' AState Form ppovedbyStae(Board of) INDIANA CERTIFICATE OF VEHICLE REGISTRATION
11.,,;,.; Accounts 2010
CLASS I AGE ISSUE DATE IPUR DATE COUNTY TP PL YR PLATE PL TP WEIGHT P ILS1 TYPE
09/04/2012 08/2412012 29-HAMILTON N 2011 MO N
EXPIRATION DATE PRIOR PLATE I VEHICLE YEAR I MAKE TYPE MODEL COLOR VEHICLE IDENTIFICATION NUMBER
NO EXP 2012 FOR TK F1S WHI/ 1FTFW1ET3CFD01817
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 DU 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 SL
CARMEL,IN 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 FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS. THAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI-
VEHICLE IDENTIFICATION NUMBER TUTE THE CRIME OF PERJURY. FUTHERMORE,I/WE 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 AD ARAN H R
--The law requires that you apply for Certificate of Title within thirty-one days from the date of purchase of a
lull—motor vehicle.There is a delinquent fee of$21.00 for failure to do so.Attach Certificate of Title assigned by seller.On err
DEALER PLATE NO. dorsed Titles,liens must be released.Supporting documents surrendered with this application cannot be returned to the apply
cant. State fee for applying for Title is$15.00.*In accordance with Federal Code 181.
TITLE NUMBER BRANCH NO INVOICE NOl BMV USE ONLY
1. 09041280300014 803 MV-GOVERNMENT-CERTIFICATE OF ORIGIN
`SOC.SEC./FEDERAL I.D.NO APPLICANT'S NAME BMV USE ONLY D
2. CITY OF CARMEL 0
STREET ADDRESS CITY STATE ZIP CODE N
3. ONE CIVIC SQUARE CARMEL IN 46032 0
VEHICLE I.D.NUMBER VEH.YEAR VEH.MAKE VEH.MODEL NO. VEH.TYPE ODOMETER ACTUAL
4. 1FTFW1ET3CFD01817 2012 FOR F1S TK 35M T
FORMER TITLE NUMBER PURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY Y
P
5.._C OF O-- — 08/24/2012 5 N No Yes - E
FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESS STREET ADDRESS
6. CITY OF CARMEL 1 CIVIC SQ I
N
CITY STATE ZIP CODE BMV USE ONLY
7 CARMEL IN 46032-2584 H
SECOND LIEN'S NAME STREET ADDRESS
8. S
CITY STATE ZIP CODE LICENSE NUMBE7 LICENSE FORMS BMV USE ONLY A
9 YEAR USED
SL R
GROSS RETAIL&USE TAX AFFIDAVIT-I/WE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW E
A
SELLING PRICE LESS TRADE-IN / DISCOUNT AMOUNT SUBJECT TO TA AMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPT
10. $ 0.00 $ 0.00 0.00 $ 0.00 $ X PUCE 1 ARA.#
Your Social Security number/Federal I.D.number is being requested by this agency under IC4-1-8-1. 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 II II I I II VIII VIII IIII VIII VIII VIII VIII I III I I
2 0 5 2 1 1 3 1 5 2 1 2
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))
$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
t
SEP 10 2012
/ A S
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund