225492 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: T362164 Page 1 of 1
ONE CIVIC SQUARE OFFICE OF INDIANA STATE CHEMIST CHECK AMOUNT: $45.00
CARMEL, INDIANA 46032 PURDUE UNIVERSITY
9M, off ca= 175 S UNIVERSITY STREET CHECK NUMBER: 225492
WEST LAFAYETTE IN 46907-2063
CHECK DATE: 10/2312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4355300 N35567-2013 45 . 00 ORGANIZATION & MEMBER
Page 1
2014 INDIANA PESTICIDE COMMERCIAL APPLICATOR RENEWAL APPLICATION
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
CARMEL IN 46033-1212
Current Phone: (317)846-7431 Ext.
Current Fax: O
Business e-mail: BHIGGINS @CARMEL.IN.GOV
r, Submit the Renewal Application and payment in the enclosed envelope before December 31,2013.
Those applications postmarked after December 31,by law,require an additional 100%late fee penalty
NOTE: Certification in each category is valid for a five(5)year period.
A license and technician registration is renewed each year prior to December 31.
License Number= N35567 C EE = $45.00 RENEW DO NOT RENEW
Personal e-mail: BHIGGINS @CARMEL.IN.GOV
ROBERT DAVID HIGGINS
r:
Category 36 13 CCHs earned out of 20 required Category Expires 12/31/2017
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**** FOR STATE CHEMIST OFFICE USE ONLY ****
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APPROVED DATE
Check No Amount Entered Under
GN 30022 Posted Account#
PAL
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FAL Amount
Total Fee Due: $45.00
2014 RENEWAL-BROOKSHIRE GOLF CLUB Page 2
Total Fee Due: $45.00
Submit the Renewal Application and payment in the enclosed envelope before December 31,2013.
Those applications postmarked after December 31, by law, require an additional 100%late fee penalty
Send to: Office of Indiana State Chemist, Purdue University, 175 S. University St.,West Lafayette, IN 47907-2063
Make check payable: Indiana State Chemist
I hereby certify that the list being submitted is a true and accurate record of the current active
employee working at this business location. I also acknowledge that failure to provide accurate information
on this application form consititutes a violation of the Indiana Pesticide Use and Application Law(IC 15.3-3.3.6 Section 65(11))
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Signature Date
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Office of Indiana State Chemist
Purdue University IN SUM OF $
175 S University Street
West Lafayette, IN 47907-2063
$45.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I N35567-2013 I 43-553.00 I $45.00 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
Thursday, October 17, 2013
Director, Brookshir 6olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
10/17/13 1 N35567-2013 I Dues I $45.00
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