319838 12/21/17 CITY OF CARMEL, INDIANA VENDOR: 354296
ONE CIVIC SQUARE HOBBY LOBBY STORES CHECK AMOUNT: $**'*****50.98*
�. ?q CARMEL, INDIANA 46032 PO Box 960070 CHECK NUMBER: 319838
9�"�rori�O` OKLAHAMA CITY OK 73196-0070 CHECK DATE: 12/21/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT, DESCRIPTION
2201 4239034 0 50.98 LANDSCAPING SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 354296 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HOBBY LOBBY STORES IN SUM OF$ CITY OF CARMEL
PO BOX 960070 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.
OKLAHAMA CITY, OK 73196-0070
Payee
$50.98
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 42-390.34 $50.98 1 hereby certify that the attached invoice(s),or 9/25/17 0 $50.98
2201 2201 2201 2201
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
Wednesday, December 13,2017
Huffman, Dave
Director
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund.
Clerk-Treasurer
S-182 R-6 T-9017 9/25/2017 2:05:00 PM
2003 E. Greyhound Pass
Carmel, IN 46033
Hobby Lobby Store #182 (317) 818-9217
5-182 R-6 T-9017 CASSIDY C SALE
106500000 Floral 15.99 N
106500000 Floral 34.99 N
SUBTOTAL 50.98
TAX TOTAL 0.00
TOTAL 50.98
A/R 50.98
ACCOUNT #: ************23319
AUTH#: 67419685
AUTH CENTER:
Signature
Cardholder acknowledges receipt
amount of the total shown herein
and agrees to perform the obligation
set forth in the cardholders
agreement with the issuer
Signature on File: 1
CHANGE DUE 0.00
Page 1
S-182 R-6 T-9017 9/25/2017 2:05:00 PM
TAX EXEMPT CUSTOMER INFORMATION:
HL ID CARD: HL2223236
FIRST NAME: CRYSTAL
LAST NAME: EDMONDSON
TITLE: FORMEN
TELEPHONE:
ORGANIZATION: CITY OF CARMEL
TYPE: 5-GOVERNMENT AGENCY
ADDRESS: ONE CIVIC SQUARE
CARMEL, IN
46032
I certify that the organization is granted
authority from the governing state and local
taxing jurisdictions to make purchases
without payment of sales tax of tangible
personal property or taxable services to be
used or consumed by the organization itself
or to be given away. I understand that if
the tangible personal property and/or
service is used other than as stated_ or for
any purpose that is not exempt from the tax_
the organization is liable for the state and
local sales taxes. I further certify that
this purchase is being made with funds
directly from the organization. Under
penalties of perjuryL I swear or affirm that
the information provided is true and correct
as to every material matter.
Signature on File: 2
Number of Items Purchased: 2
9/25/17 02:05 PM
Page 2