243211 09/09/15 - CITY OF CARMEL, INDIANA VENDOR: 060700
ONE CIVIC SQUARE CLARK TIRE INC CHECK AMOUNT: $"*"*"'"*27.50'
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK NUMBER: 249211
CARMEL IN 46032 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 146263 27.50 AUTO REPAIR & MAINTEN
i
CARMEL All Claims and Returns MUST Be Accompanied By THIS INVOICE
622 C. South Rangeline Road TERMS:NET 10TH FOLLOWING DATE OF PURCHASE.A SERVICE CHARGE
LARK, Carmel, IN 46032 OF 13 PER MONTH WILL BE ADDED TO PAST DUE BALANCE(MINIMUM
(317)844-4839 CHARGE.75).THE ANNUAL PERCENTAGE RATE IS 21%.
FAX(317)844-6561 AGRICULTURAL EXEMPTION CERTIFICATE
STATE DEPARTMENT OF REVENUE—SALES TAX DIVISION
I HEREBY CERTIFY UNDER THE PENALTIES OF PERJURY THAT THE PERSONAL
PROPERTY PURCHASED BY THE USE OF THIS EXEMPTION CERTIFICATE WILL BE
DIRECTLY USED IN THE DIRECT PRODUCTION OF AGRICULTURAL PRODUCTS FOR
TWORESALE.
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® CUSTOMER'S SIGNATURE
UNIROYAL
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CARMEL FIRE DEPT: 5900/01 SAME INVOICE# 146263
SOLD TO: TWO CIVIC SQUARE SHIP TO:
CARMEL IN 46032
CUST. P.O.# MAKE-MODEL ID# MILEAGE TELEPHONE "ROUTE SLM SHIP VIA ORDER# PAGE REMARKS
Dj@4i9j4jl 511-2609 !b 11H 1 IW2511
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
t1 NUMBER _� INVOICE NUMBER s
pened by.,Operator #.. ,
08/19/2015 ! 146263 NET 10TH EEM/19/15 09:34:17 7
STOCK NUMBER SIZE DESCRIPTION - °unrrrny=SHIPPED--PREY.SHIP, PRICE
--- UNIT
RS–' T " F.E.T. EXTENSION
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1 !tlt i F1{Lh 1Ht t k f
L%,
17 117/18" DISMOUNT & MOUNT PASSENGER 1• 1 i 18.00 .00 `18:
COMBIO !EACH (COMBINATION REPAIR ON VEHICLE "1 1 9.50 .00 ,. 9.50
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METHOD OF PAWINT:
CHARGE: 27.50 ; I
CHANGE: .00 �� f
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PARTS, LABOR TAX% CUStRAMoU`N`T�saIe,N0. TAX F.E.TMISC PLEASE ItJIVOT0E:TOCAL1T
AMOUNT
27.50 1)03120155-002-Q 27.50
"Ours Is A Reputation You Can Ride On"
CUSTOMER COPY
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))
146263 8304 $27.50
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 Rangeline Road
Carmel, IN 46032
$27.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 146263 43-510.00 $27.50 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
SEP - 4 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund