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Home My WebLink About227399 12/17/2013 �.f CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURITY AMOUNT: $240.00 CARMEL, INDIANA 46032 DIV OF ELEVATOR W WASHINGTON ST RM E22AL OFF].`,` '.. CHECK NUMBER: 227399 INDIANAPOLIS IN 46204 CHECK DATE: 12/17/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 f 4358300 734241202220 240 . 00 OTHER FEES & LICENSES ELEVATOR OPERATING CERTIFICATE INVOICE ARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032 1.If Code = * An annual test report is due before a permit is issued. 2.If Code = # A 5 year Test report is due before a permit is issued. 3.Over due fees must be paid before a permit is issued. If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. State No.Code Due Over Due Location Address 111704 $120.00 $ 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032 111978 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032 cC�?�°�r'z P'P evcc '� 10`� DEC 33 2013 1 oql-�358300 ��: �� >09/- u35��o� '- /�'u� Reference Number Invoice Date Please submit ENTIRE document with ayment 734241-12022013 -1 12/02/2013 Unit(s) 2 Total Due upon receipt of 2 $ 240.00 of $ 240.00 n - -Y - xa.t - r•a-? taa.p +a,a.*, ;'t :;ft ..t N tAPq . ,,P. ►k .R q '► �r'Rw.a St f.�li j= �f��-,q ''stiiy �. •�f 1 �: ;�� '' k>•� 1,+ �- �,,��E._:z� t+::�^�';.;; ��:a��• .��' �'s.a� �+�d+ -"`V.4 70 1 4 .». { 4 "0� { 4 r°' 1�0 { .� 4+Y' 70 3 . 4 �• �y�+ I j st` ±r.�t::. ut�` �_ �^ -JiJ ��._• - i� w_,-ii r��^'t .y<• r4�� ti ,yt� r� '.r��. },'►i ( t }Vi C � }'i ,,�• T �} � w�:`• T° �.�v� <• X• J i r J. ,� �. .. r ► t ► Y. t � �hT—i '4' °t �Ti i '�i'�"° 4 '"T—i i' °. 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ELEVATOR OPERATING CERTIFICATE INVOICE i ARMEL/CLAY BOARD OF PARRS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032 } 1.If Code = * An annual test report is due before a permit is issued. 2.If Code = # A 5 year Test report is due before a permit is issued. 3.Over due fees must be paid before a permit is issued. If elevator(s) are not in service please request an "ELEVATOR OUT OF SERVICE AFFIRMATION" form. (� State No.Code Due Over Due Location Address 111704 $120.00 $ 0.00 1235 CENTAL PARK DR EAST, CARMEL IN 46032 j 111976 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 46032 i M E _ aeva . ( _ �U; r 3�2 JCS Reference.Number Invoice. Date,: Please submit ENTIRE document with ayment 7342'411202201`3 'Unit(s) 2 Total Due upon receipt of 2 $ 240.00 of $ i i Owner Id 734241 Ref.Num. :734241-12022013 -1 $240 of $ 240.00 Invoice Date 12/02/2013 a _ If Paying by check, include a check made payable to the Department bf Homeland=security,;You can pay all your payments online at IDHS web site https://myorac1e.in.gov/dfbs%idhsFeesi—nea%star do wwith Visa/Master Card/Discover cards. Use Owner Id on this letter or State Number on the invoice to pul-1-up-information-when paying_-the,_duea online OR complete the following information and return by mail :IndianaTDepartment bf ' - Y. _ _ - ✓ ,r. Homeland-Security �Flscal Department 302 W Washington 4St Rm E221 Ind anapo3is `IN- 462`04 oi.�fax to j (317)233-0401. Questiona7 call(317)'232=6427 of E mail elevator-invoice @dhs.ia.gov 2.25 conveai nce fee charged on all credit card payments. i Full Name on Credit Card Billing Address: Street City State Zip Code CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one) Acct. Number Exp.Date (mm/yy) CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's Agreement with the issuer. Ref.Num. :734241-12022013 -1 $240 of $ 240.00 Invoice Date 12/02/2013 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 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 12/2/13 73424120222013 Elevator permits 2014 $ 240.00 Total $ 240.00 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. 229400 Department of Homeland Security Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of$ $ 240.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Mernbers Dept# 1091 73424120222013 4358300 $ 240.00 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 12-Dec 2013 Signature $ 240.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund