250321 1 0/07/1 5 � Coq
CITY OF CARMEL, INDIANA VENDOR: 369144
r ONE CIVIC SQUARE LSQ FUNDING GROUP LC CHECK AMOUNT: S""""""""66.75*
CARMEL, INDIANA 46032 PO Box 404322 CHECK NUMBER: 250321
ATLANTA GA 30384-4322 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4356006 INV713240483 66.75 GOLF SOFTGOODS
I
i
new t a Invoice
0 L F Acct. No. Date Invoice#
20005615 9/21/2015 1NV713240483
Klone Lab Check Payable To:
9 Water Street, 3rd Floor LSQ Funding Group, L.C.
Amesbury MA 01913 P.O. Box 404322
978-378-3434 Atlanta, GA 30384-4322
Bill To Ship To
J
City of Carmel City of Carmel
Brookshire Golf Course Brookshire Golf Course
12120 Brookshire PkNvy 12120 Brookshire, Pkwy
Carmel IN 46033 Carmel IN 46033
Terms Due Date PO# #of Units Billed Sales Rep
Net 60 11/21/2015 Henry 0 Tom Richardson
Currency Shipping Method Tracking#
I. S Dollar UPS Ground 17.,86402F0300679621
Style Description Quantity Price level Unit Price Amount
NBG1701WK-8.5 4E NBG1701 1 Base Price 55.00 55.00
This account is assigned and payable only to LSQ Funding
Group,L.C. Subtotal. 55.00
Payments should be sent to them at: Shipping and Dandling(tiTS Ground) 11.75
LSQ Funding Group,L.C. Total 66.75
P.O.Box 404322 AnlountDue $66.75
Atlanta.GA 30384-4322
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))
09/22/15 INV713240483 Soft Goods $66.75
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
LSQ Funding Group, L.C.
IN SUM OF $
P.O. Box 404322
Atlanta, GA 30384-4322
$66.75
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1207 I INV713240483 I 43-560.06 I $66.75 I 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
Monday, September 28, 2015
r
Z-<=—� 6Q a/
Director, Brookshire olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund