248768 08/26/15 4 CITY OF CARMEL, INDIANA VENDOR: 060700
® 'r. ONE CIVIC SQUARE CLARK TIRE INC CHECK AMOUNT: $ .....*25.50'
s' a° CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK NUMBER: 248768
+.y`�iroN,�, CARMEL IN 46032 CHECK DATE: 08/26/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 146116 25.50 AUTO REPAIR & MAINTEN
622C S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION" LARK Carmel IN 46032
4w (317) 844-4839
IRE
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I,THE UNDERSIGNED,HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY 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) RECEI VED BY
SOLD TO: CARMEL FIRE DEPT. 5900/01 SHIP TO-`SAME INVOICE# 146116
TWO CIVIC SWARF
CARMEL IN 46032
CUST.P.O.# MAKE-MODEL ID# MILEAGE TE`L:j6R „f E ROUTE SLM SHIP VIA ORDER# PAGE REMARKS
F 250 4163192 4211 571-2609 0 5 N/A 169989,. 1
INVOICE PREVIOUS SHIPPED
INVOICE DATENUMBER INVOICE NUMBER TERMS
nopnOd hy npPrAtnr
08/05/2015 146116 NET 10TH 08/05/15 10:10:51 8
STOCK NUMBER SIZE DESCRIPTION aTv UNIT
SHIP
ORDERS SHIPPED PREV.SHIP PRICE T F.E.T. EXTENSION
LEFT REAR TIRE REPAIR
16 160 DISMOUNT & MOUNT PASSENGER 1 1 16.00 .00 16.00
REPO EACH INSIDE REPAIR ON VEHICLE 1 1 9.50 .00 9.50
METHOD OF PAYMENT:
CHARGE: 25.50
CHANGE: .00
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PARTS LABOR TAX% CUStOA e% ale N4. TAX F.E.T. AMO NT PLEASEINV, .11�qjTNT
25.50 r120155-N2-0� 25159 ``..
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"You're Riding On Our Reputation”
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))
146116 $25.50
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.
ALLOWED 20
Clark Tire
IN SUM OF $
622 South Rangeiine Road
Carmel, IN 46032
$25.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 146116 43-510.00 $25.50 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
AUG 2 4 2015
14 L.4' 14 -
RV Yr V'Ili
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund