223893 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1
ONE CIVIC SQUARE DEPARTMENT OF HOMELAND SECURITY
CARMEL, INDIANA 46032 BOILER AND PRESSURE VESSEL DIVISIO CHECK AMOUNT: $49.00
302 W WASHINGTON ST RM 246 CHECK NUMBER: 223893
INDIANAPOLIS IN 46204-2739
CHECK DATE: 9/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 323313 49 . 00 BUILDING REPAIRS & MA
Cl
T'
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� 2013
INVOICE FOR INSPECTION / CERTIFICATE FEES
yo State Form 356(R4/9-93)
jy Approved by the State Board of Accounts-1991 BY;
Division of Fire and Building Safety
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://myoracle.in.gov/dfbs/idhsFeesFines/start.do
INSTRUCTIONS: Boiler and Pressure Vessel Safety Division with Visa/Master Card/Discover cards.Use Owner Id on
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
INDIANA STATE
- - - : rat>. �- - --- -----
1 �1 - --
NUMBER :`i Dt'Otl /1 l�
LATEST P-LEASE
323313 1. R /mil/ fl Or F INVOICE PAY THIS
CARMEL CLAY PARKS & RECREATION-- DATE AMOUNT!
Owner Id 1411 E 116TH ST h.l-• w UI C�
J
759531 i CARMEL, IN 46032-3455 i? %-escr J� •n,(/lCt�l✓�CI �ltt�ti Q/ 08/16/2013 `_\/
Owner number User Name&Location of vessel i= h^SF" Gate Fee
MONON COMMHN-I�I-C-EN�EFt
1195 CENTRAL PARK DR w ;.., Oval g 49.00
CARMEL IN 46032
-----------
Serial number Description of vessel Manufacturer Date Last Inspected
W T Boiler LOCHINVAR 107/23/2013
National Board No. Inspection agency Name of inspector This fee is
238763 STATE OF INDIANA PARKEY LARRY E prescribed by
675 IAC 12-3-13)
Inspection Date Inspector Name Inspection Type Due
07/23/2013 PARKEY LARRY E FIRST INSPECTION--323313,08/16/2013 $ 49.00
PLEASE NOTE THIS SHEET CONTAINS 2 DUPLICATED INVOICE, PLEASE CUT SHEET ON
LINE AND RETURN BOTTOM COPY WITH PAYMENT
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
229400 Indiana Department of Homeland Security Terms
Fiscal Department
302 W Washington St., Rm E221
Indianapolis, IN 46204
Invoice ; Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/16/13 323313 Flowrider boiler inspection $ 49.00
Total $ 49.00
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
20_
Clerk-Treasurer
Voucher No. Warrant No.
229400 Indiana Department of Homeland Security Allowed 20
Fiscal Department
302 W Washington St., Rm 2q6
Indianapolis, IN 46204- 273q In Sum of$
$ 49.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1093 323313 4350100 $ 49.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services eternized thereon for
which charge is made were ordered and
received except
5-Sep 2013
Signature
$ 49.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund