HomeMy WebLinkAbout252931 12/29/15 ♦.W C�gNf
CITY OF CARMEL, INDIANA VENDOR: 357304
® ONE CIVIC SQUARE JAMES HOBBS CHECK AMOUNT: $*—.....60.01"
x. �4 CARMEL, INDIANA 46032 11180 E.111TH STREET CHECK NUMBER: 252931
�M roe , FISHERS IN 46038 CHECK DATE: 12/29/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231300 60.01 DIESEL FUEL
GALLAHAN TRAVEL PLAZA /JCT US 31 AND US 24 /PERU, IN 46970/ (765) 472-1963
Number: 0101-0319 12/21/2015 Station : 1
Response: APPROVED H30304
Pump Products Reefer Quantity Unit Cost Total
# 3 DIESEL 2 N 27. 289
subtotal = 60. 01
sales tax = 0. 00
TOTAL = 60. 01 Signature :
pree to pay total amount
cording o card suer agreement.
Salesperson ID: JB/ALL, CASHIERS Invoice #: 01010319
Truck Number: 1 Sequence Number: 017669
DOT Number: 00312015 Merchant Number: 040845
Transaction Type : PURCHASE
-SWIPED-
Billing Company : BUYPASS /
Company Name : CARMEL STREET DEPARTMENT
IF INDIANA SALES TAX NOT COLLECTED, I CERTIFY, UNDER THE PENALTIES OF PERJURY
THAT THE PROPERTY BEING PURCHASED IS FOR AN EXEMPT PURCHASE. PURSUANT TO THE
STATE GROSS RETAIL SALES TAX ACT ICG-2. 5. FEDID#351274616 - NO EVIDENCE OF DYE
IN FUEL.
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s) or bill(s))
12/21/15 01010319 $60.01
2201 201
I 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.
JAMES HOBBS ALLOWED 20
11180 E. 111TH STREET IN SUM OF $
FISHERS, IN 46038
$60.01
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
01010319 I 42-313.00 I $60.01 I hereby certify that the attached invoice(s), or
2201 201 Prior Year
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
wday, Dece >1 2015
>' v
Street Commissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund