249002 08/26/15 u
'�� CITY OF CARMEL, INDIANA VENDOR: 369794
4 ONE CIVIC SQUARE READY REFRESH BY NESTLE CHECK AMOUNT: $ ......18.21
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rp CARMEL, INDIANA 46032 PO BOX 856680 CHECK NUMBER: 249002
9.y.._ o, LOUISVILLE KY 40285-6680 CHECK DATE: 08/26/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 15HO11925282 18.21 OTHER MAINT SUPPLIES
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Refresh_ #215 6661 DIXIE HWY,SUITE 4 07/13/15-08/12-/-15 15H0119252823
LOUISVILLE KY 40258
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CITY OF CARMEL STREET DEPARTMENT Customer Service: 1-800-274-5282
BONNIE CALLAHAN For your convenience,you can pay your bill online.It's
3400 W 131ST ST
CARMEL IN 46074-8267 fast and easy!
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Delivery address: CITY OF CARMEL STREET DEPARTMENT,1 CIVIC SQUARE,CARMEL IN 46032
PREVIOUS BALANCE 18.21
8/06 269076 PAYMENT-THANK YOU -18.21
8/12 0951269554 2 5 GAL ICE MOUNTAIN DIRK W/HANDLE 6.98
2 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 12.00
1 9 OZ PLASTIC CUP_,50C/SLV 3.29
2 5 GALLON ICE MOUNTAIN-DEPO-SITtRET_URN -12.00
0953906583 1 DELIVERY FEE - -',' ` ` %! 3.95
H9014018 RENT 3.99
TOTAL 18.21
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ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT
Subject to terms on reverse side. 18.21 — 18.21 + 18.21 = 18.21
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BILLING RIGHTS SUMMARY
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR Date range of this invoice SAMPLE INVOICE
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separate sheet of paper.We must hear from you in writing no
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later than thirty(30) days after we sent you the first bill on y – Dillnnllnea.•�•� paid in full to
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which the error or problem appeared.You can telephone us, last invoice Delivery Address.)ohn ON,123AA In 5t,"ty Sta" ,
but doing so will not preserve your rights.In your letter,give x%%
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while it is being investigated. During the investigation, we — ., Amount due
cannot report your account as delinquent or take any action
133 Main St
to collect the amount in question. _ Cny's`a`e °°°°°
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GENERAL INFORMATION payment by
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1. Past due invoices(not paid within 30 days of billing
date)may be assessed a late fee as allowed by law not
to exceed$20 per month.Additionally,third party
collection/attorney expenses may be assessed at a YOUR INVOICE-4 WAYS TO HELP US SERVE YOU BETTER
rate not to exceed 100%of the unpaid balance or the 1. Please remember payment is due by the "pay by” date noted to ensure the
maximum allowed by law. smoothest service.
2. Each returned check is subject to a service charge 2. Remember,if you are renting equipment,your equipment rental is charged one
subject to the maximum check return charge allowable month in advance.That means your first invoice will include a pro-rated fee for
in your State. the current month,plus the next month's rental.
3. Equipment replacement costs will be charged for 3. Kindly fill in the amount enclosed,include your account number on your check
bottles lost,stolen,damaged or not returned. and do not send cash.If you prefer,you can pay your bill online at:
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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))
08/14/15 15HO 119252823 $18.21
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
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IN SUM OF $
P. O. Box 856680
Louisville, KY 40285-6680
$18.21
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 115HO119252823 I 42-389.001 $18.21 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
Thu s ay, 15
reed om e
ree Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund