218015 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 362497 Page 1 of 1
ONE CIVIC SQUARE DEPT HOMELAND SECURITY
CARMEL, INDIANA 46032 302 W WASHINGTON CHECK AMOUNT: $360.00
RM E221 CHECK NUMBER: 218015
INDIANAPOLIS IN 46204
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 120 . 00 7675-03012013-1
1205 4351501 120 . 00 7675-02282013-1
1205 4351501 120 . 00 7675-03012013-1
ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL PUBLIC WORKS & SAFETY ONE CIVIC SQ CARMEL IN 46032
1 . If Code = * An annual test report is due before a permit is iss
2 . If Code = # A 5 year Test report is due before a permit is issu
3 .0ver due fees must be paid before a permit is issued.
If elevator (s) are not in service please request an "ELEVATOR OUZ
AFFIRMATION" form.
State No.Code Due Over Due Location Address
45583 $120.00 $ 0.00 1 CIVIC SQ, CARMEL IN 46032
D
MAR
By
Reference Number Invoice Date Please submit ENTIRE c
7675-02282013 - 1 02/28/2013 Unit (s) 1 Total Due u
of 1 $ 120
Owner Id 7675
Ref .Nuin. : 7675-02282013 - 1 $120 of $ 120 . 00 Invoice Date
If Paying by check, include a check made payable to the Department of Homeland sec
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesFines/start.
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice tc
paying the dues online.OR complete the following information and return by mail :1
Homeland Security, Fiscal Department, 302 W.Washington St. , Rm : E221, Indianapoli:'
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice @dhs.in.gov
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Am.Express/Discover/Master Card ONLY (circle one) (VISA
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature_
By signing, cardmember agrees to the obligations set forth by the
Agreement with the issuer.
ELEVATOR OPERATING CERTIFICATE INVOICE
CARMEL PUBLIC WORKS & SAFETY ONE CIVIC SQ CARMEL IN 46032
1 . If Code = * An annual test report is due before a permit is iss-
2 . If Code = # A 5 year Test report is due before _a permit is issu,
3 .Over due fees must be paid before a permit is issued.
If elevator (s) are. not in service please request an "ELEVATOR OUT
AFFIRMATION" form.
State No.Code Due Over Due Location Address
45581 $120.00 $ o.00 3 CIVIC SQ, CARMEL IN 46032 ---ow
45582 $120.00 $ 0.00 1 CIVIC SQ, CARMEL IN 46032
Jr�
12
D
By-
Reference Number Invoice Date Please submit ENTIRE docun
7675-03012013 -1 03/01/2013 Unit (s) 2 Total Due ul
of 2 $ 240 .
Owner Id 7675
Ref.Num. : 7675-03012013 - 1 $240 of $ 240 . 00 Invoice D.
If Paying by check, include a check made payable to the Department of Homeland sec
payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesPines/start.
Card/Discover cards. Use Owner Id on this letter or State Number on the invoice tc
paying the dues online.OR complete the following information and return by mail :I
Homeland Security, Fiscal Department, 302 W.Washington St. , Rm : E221,Indianapolis
(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice®dhs.in.gov
charged on all credit card payments.
Full Name on Credit Card
Billing Address: Street
City State Zip Code
CC type:Am.Express/Discover/Master Card ONLY (circle one) (VISA F
Acct. Number Exp.Date (mm/yy)
CVV2 Number Contact Phone Number Signature_
By signing, cardmember agrees to the obligations set forth by the
Agreement with the issuer.
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))
02/28/13 7675-02282013-1 $120.00
03/01/13 7675-03012013-1 $120.00
03/01/13 17675-03012013-11 Police 1 $120.00
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
Department of Homeland Security
IN SUM OF $
302 W. Washington, Rm E221
Indianapolis, IN 46204
$360.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 7675-02282013-1 43-515.01 $120.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1205 7675-03012013-1 43-515.01 $120.00
1 materials or services itemized thereon for
7675-03012013-1 .50 $120.00 which charge is made were ordered and
received except
Monda March 11, 2013
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund