244678 04/29/15 ,��.c,A4R. CITY OF CARMEL, INDIANA VENDOR: 060700
`°` CHECK AMOUNT: $""""'79.45`
��I• ONE CIVIC SQUARE CLARK TIRE INC
r CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK NUMBER: 244678
�M,�TON�:? CARMEL IN 46032 CHECK DATE: 04/29/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 144926 79.45 OTHER EXPENSES
LARK 622C S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 46032
f..�, (317) 844-4839
IRE
afiOnal PENN IL
1,THE UNDERSIGNED,HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HER PURCHASED AND SELLER SHALL HAVE
A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID.I FURTHER AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE,AND
IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING
AGENCY AND ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BY LAWS GOVERNING THESE TRANSACTIONS.
A finance charge of 13/4%Per Month will be charged on all Accounts 30 days Past Due.Annual Percentage Rate is 21%.(Minimum 75) RECEIVED BY
SOLD TO: SHIP TO:
CARMEL WATER DISTRIBUTION 6300/01 91tE INOIDICE4 '14492E
34'50 14. 131ST ST.
CARiF__L IN 4a,174
CUST. P.O.# MAKE-MODEL ID# MILEAGE TELEPHONE ROUTE SLM SHIP VIA ORDER# PAGE REMARKS
715-3939 0 1 ?111/F? 1675173, 1
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
opened ny uperator 4
04/03/2M 144Q26 NET 10TH 04/03/15 16.01..752 /
STOCK NUMBER SIZE DESCRIPTION QUANTITY UNIT T F.E.T. EXTENSION
_. ORDERS SHIPPED PREY SHIP PRICE
REPAIR TIRE LOOSE .
Ct EP,LF! TIRE CF'rNGE i 1 LO,@?, ,lad 3O.al
°OOTI. EW,11 NEDIUM BOOT REPtAIR 1 1 8.110 02 .00 8.00
CCrSHI EACH IMESH DE COMBINDT:ON! REPAIR 1 1 E.50 .CIltt 6.50
@364 12,q 16.5 CODER TUBE 1 i 3.4.95 I`'2 .d 34,95
KETHOD OE PA'T NT:
CHARK: 79.45
i_t-AN GE. .011
t
r
Thank you for your bminess klech. Rall
PARTS LABOR TAX% TAXABLE TAX F.E.T. misc. INVOICE TOTAL
AMOUNT AMOUNT PLEASE PAY _
HIO ANGUNT
7 9.45TT 79.-'S
"You're Riding On Our Reputation"
VOUCHER # 151583 WARRANT# ALLOWED
60700 I IN SUM OF $
CLARK TIRE INC CARMEL
622 C SOUTH RANGELINE RD
CARMEL, IN 46032
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
�1
3 f
Board members
.I
PO# INV# ACCT# AMOUNT Audit Trail Code
144926 01-6500-05 $79.45
4
r
I
1
I
j
I�
I
1'
Voucher Total $79.45
Cost distribution ledger classification if
claim paid under vehicle highway fund
l: I.
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
l An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
60700
I CLARK TIRE INC CARMEL Purchase Order No.
622 C SOUTH RANGELINE RD Terms
CARMEL, IN 46032 Due Date 4/21/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/21/2015 144926 $79.45
i
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
Date Officer