217525 02/25/2013 CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1
ONE CIVIC SQUARE I N S C C U-ASFE
CARMEL, INDIANA 46032 PO BOX 6271 CHECK AMOUNT: $110.00
t?� INDIANAPOLIS IN 46206-6271
<„ �a CHECK NUMBER: 217525
CHECK DATE: 2/2512013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 0004324952 55 . 00 OTHER EXPENSES
101 5023990 0005291191 55 . 00 OTHER EXPENSES
#BWNNXZL
#0002 8378 36T#
WILLIE H. COLLINS
11931 BLACK HILLS DR
FISHERS IN 46038-5487
PLEASE RETAIN THIS PAGE FOR YOUR RECORDS
COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT
291302-0509-DR-0833
$55.00
Total ASFE Due for the above listed cases $110.00
Proleclif7,o our cbildren,1Uwilies and iaaure
Michael R.Pence,Governor
John P Ryan,Director
Indiana Department of Child Service
Child Support Bureau
' MSII
0 402 W.Washington Street
Indianapolis,Indiana 46204-2739
317-233-5437
° FAX.317-233-4925
www.in.gov/dcs
Child Support Hotline:800-840-8757
01/19/2013 Child Abuse and Neglect Hotline:800-800-5556
ANNUAL. SUPPORT FEE NO'T'ICE
The Indiana General Assembly set the amount of the Annual Support fee at$55.00, effective January 1, 2008.
Employers please note: In instances where the Child Support Bureau does not have the address of the non-custodial
parent (NCP),this notice is sent in the care of the NCP's last known employer. Employers are asked to forward this notice
to your employee,or inform the Child Support Bureau if the non-custodial parent is no longer employed with your company.
Dear WILLIE H. COLLINS,
This notice is to inform you that pursuant to IC 33-37-5-6 and IC 31-16-15,the 2013Annual Support and Maintenance
Docket Fee (ASFE) for the listed child support case(s) shown below is due by 06/30/2013. The $55.00 fee is due for each
and every individual case. In order to assure proper credit,you must include the coupon on the bottom of this notice with
your payment. In addition please remember to write on your check or money order the ISETS case number(s) listed on
the coupon and clearly note that the payment is for the ASFE.
DO NOT COMBINE your ASFE payment with a child support payment or you may not receive proper credit for the
payment of this fee. This is the only notice you will receive for this year's fee, this calendar year. If the total amount shown
is not received by 06/30/2013, an Income Withholding Order .ill be sent to your employer to withhold the balance owed for
the current year's fee for each and every individual case eligible for income withholding. If you have any questions about this
notice, please contact the Kidsline at (317)233-5437 or (800)840-8757.
Please note:you may also receive an ASFE notice from your County Clerk's office regarding any past due ASFE balances
from previous years. Please contact the County Clerk about those notices.
Thank you
Indiana State Child Support Bureau
Department of Child Services
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
SCE=q '�q Purchase Order No.
+U/,-,2 // Terms
/X Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
t
"F
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 SUM OF $
/til �, ��� ��27/
it ON ACCOUNT OF APPROPRIATION FOR
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iD
Board Members
Po#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# 1 hereby certify that the attached invoice(s), or
),;23lyo ,;cro bill(s) is (are) true and correct and that the
oL)e v3�yis�. - �,yrl S—� materials or services itemized thereon for
which charge is made were ordered and
received except
203
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Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund