250171 1 0/07/1 5 � CSA .
? CITY OF CARMEL, INDIANA VENDOR: 00351640
® 'i _ ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $ ....'284.28*
�. _� CARMEL, INDIANA 46032 PO Box 195 CHECK NUMBER: 250171
'M�roN.�. FISHERS IN 46038 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 9018 284.28 EQUIPMENT REPAIRS & M
; e 9018
NAME DATE
CLARK TIRE FISHERS WHOLESALE
ADDRESS 126TH STREET & S.R. 37 N.
P.O. BOX 195
CITY STATE ZIP FISHERS, IN 46038
317-842-0544 1-800-444-5985
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P.O.NUMBER VEHICLE NO./I.C.C.NO. TERMS TIME RECD. TIME PROMISE HOME PHONE BUSINESS PHONE
• • DESCRIPTION UNIT TOTAL
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ALL CLAIMS AND RETURNS MUST BE ACCOMPANIED BY THIS INVOICE. /-� SUB TOTAL
A SERVICE CHARGE OF VK%PER MONTH(21%ANNUALLY)WILL BE CHARGED ON ALL ACCOUNTS PAST DUE 30 DAYS.NET 10th PROX.
AGRICULTRUAL EXEMPTION CERTIFICATE F.E.T.
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 SALES TAX
EXEMPTION CERTIFICATE WILL BE DIRECTLY USED IN THE DIRECT PRODUCTION OF AGRICULTURAL PRODUCTS FOR RESALE.
Signaturo X
nmousa wcw sccumrr NO
I,THE UNDERSIGNED,HEREBY AGREE THAT IN THEi VEN_ Qf DEFAULT IN HE PAYMENT OF,ANY AMOUNT DUE,AND IF p
THIS ACCOUNT IS PLACED IN THE HANDS OF ANgqGG�N�y�R ATTAR Y /COLLECC��lON OR LEGAL ACTION,TO PAY AN Q
ADDITIONAL CHARGE EQUAL TO TjlPICOST OF ''ECT10N INCLU CY ANIfATTORNEY FEES AND COURT COSTS
INCURRED AND PERMITTED BY WWS GOV CO.G E
TRANSACTIONS. ,
. JJJ
V _ RECEIVED BY
CLARK TIRE FISHERS CASH 0 CHARGE
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))
09/23/15 I 9018 I Repair Parts I $284.28
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 Fishers
IN SUM OF $
P.O. Box 195
Fishers, IN 46038
$284.28
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1207 I 9018 I 43-500.00 I $284.28 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
Friday, October 02, 2015
Director, Brookshi olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund