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Home My WebLink About228041 1 /14/2014 ��.F CITY OF CARMEL, INDIANA VENDOR: 229400 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF HOMELAND SECURI CARMEL, INDIANA 46032 DIV OF ELEVATOR SAFETY-FISCAL OFFI HECK AMOUNT: $120.00 �� 302 W WASHINGTON ST,RM E221 '`,.a»�o� CHECK NUMBER: 228041 INDIANAPOLIS IN 46204 CHECK DATE: 1/14/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4358300 120 . 00 73424120222013 ELEVATOR OPERATING CERTIFICATE INVOICE CARMEL/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 apermit is issued. 3.Over due fees must be paid before- a hermit 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 111703 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 p 1 x X - X14 7 43-`b3C7� DEC 2 7 2013 ky Reference Number Invoice Date Please submit ENTIRE document with payment 734241-12262013 -1 12/26/2013 Unit(s) 1 Total Due upon receipt of 1 $ 120.00 of $ 120.00 t i i ELEVATOR OPERATING CERTIFICATE INVOICE i ARMEL/CLAY BOARD OF PARKS & RECREATION 1411 E 116TH ST Pat Schlemmer CARMEL IN 46032 i l.lf 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 111703 $120.00 $ 0.00 1235 CENTRAL PARK DR EAST, CARMEL IN 40632 ED Dj i i Reference Number Invoice Date Please submit ENTIRE document with payment 734241-12262013 -1 12/26/2013 Unit(s) 1 Total Due upon receipt of 1 $ 120.00 of f,$ 120.00 - Owner Id734241 Ref.Kum. :734241-12262013 -'1 $120 of $ 120.00 Invoice Date 12/26/2013 If Paying by check, include a check made payable to the Department of Homeland security., You can pay all your payments online at IDHS web site https://myoracle.in.gov/dfbs/idhsFeesPines/start.do with Visa/Master Card/Discover cards. Use Owner Id on this letter or State Number on the invoicetopull up information when paying the dues online.OR complete the following information and return by mail ;Indiana Department of ?Homeland Security, Fiscal Department, 302 W.Washington St., Rm E221,Indianapolis,-_'_IN 46204 or fax to '-(317)233-0401. Questions? call(317)232-6427 or E-mail:elevator-invoice®dhe.in.gov 2.25% convenience fee charged on all credit card payments. Full Name on Credit Card Billing Address: Street f 1 city State Zip Code i CC type:Visa/Am.Express/Discover/Master Card ONLY (circle one) 1 Acct. Number Exp.Date (mm/yy) i CVV2 Number Contact Phone Number Signature By signing, cardmember agrees to the obligations set forth by the Cardmember's Agreement with the issuer. Invoice Date 12/26/2013 Ref.Num. :734241-12262013 - 1 $120 of $ 120.00 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 229400 (Indiana) Purchase Order No. 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 12/26/13 73424120222013 Elevator permits 2014 $ 120.00 Total $ 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. (Indiana) 229400 Department of Homeland Security Allowed 20 Fiscal Department 302 W Washington St., Rm E221 Indianapolis, IN 46204 In Sum of$ $ 120.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center I PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1091 73424120222013 4358300 $ 120.00 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 r 9-Jan 2014 Signature $ 120.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 1 1