181368 01/13/2010 -`.c. CITY OF CARMEL, INDIANA VENDOR: 361536 Page 1 of 1
ONE CIVIC SQUARE R T TIRE AUTO TIPTON
CARMEL, INDIANA 46032 804 W JEFFERSON ST CHECK AMOUNT: $283.96
TIPTON IN 46072
CHECK NUMBER: 181368
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 R5023990 W09075 008583 283.96 TIRES
7.
R a T TIRE AUTO TIPTON
804 W. JEFFERSON ST
TIPTON, IN 46072
(765)675 -6775 6000
E�
INVOICE 12/14/09 12/14/09
O0$5 83 09:54 AM 09:54 AM G¢m!
1565 001644- 008583 TERR: 1565
PAGE: 01 COPY: 01 NONSIG: 155050
BILL TO: CARMEL WATER DEPARTMENT
JIM HAAG
3450 W 131ST ST
WESTFIELD, IN 46074
PHONE 1 (765)733 -2853 EXT. VEH YEAR /MAKE.
PHONE 2 VEHICLE MODEL.
DATE REQUESTED 12 /14/09 VEHICLE COLOR.
TIME REQUESTED LICENSE /STATE.
RETURN PARTS NO ODOMETR IN /OUT NA.
SALESMAN 009 009 PRIOR INVOICE. NEW CUSTOMER
ACCOUNT COB TC CUST# TYPE /STATE
156502549 4 00 62549 3 IN
SLSM TECH PRODUCT CODE BC QTY DESCRIPTION PARTS LBR /EXCISE LINE TOTAL
009 016 046 -100 R 1 UNIT #26 .00 .00 .00
009 183 783 -418 -0 G 2 P235/70R17 108S XL WRL SR -A OWL TL 131.73 .00 263.46
G5 NUMBER. 60730929 QTY. 2 NO. MKMNTHR0309
009 016 041 -263 R 2 NEW VALVE STEM 2.00 .00 4.00
-009_ 01.6 044 -263 R 2 WHEEL_R.AI ANCE—COMPUTER. -SPIN _..00_._ 8 -.00. 16- 00_.___-
h -P
A wo ck,.,
4. L.i i PARTS TOTAL 267.46
411,4 1 p� CHARGED AMOUNT 283.96 LABOR TOTAL 16.00
l 4 6 )0 STATE TIRE FEE .50 SUB TOTAL 283.46
xx!l TAXABLE AMOUNT .00 SALES TAX .00
oSTsMER AUTHORIZA ON FOR TOTAL I N V O I C E T O TA L 2 3 9 E3
BUYING PLAN... A OF PAYMENTS. 1 PAY START DATE 01/10/10 DISCOUNT *NET*
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W ARN INO ANC, WARRANTY 1NF ORMAT I0 NI
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VOUCHER 093939 WARRANT ALLOWED
T132 IN SUM OF$
R T TIRE AUTO TIPTON _0.'
,804, W JEFFERSON ST
TIPTON, IN 46072
"413 AN
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
i
ob 008583 01- 6500 -04 $283.96
Voucher Total $283.96
Cost distribution ledger classification if
claim paid under vehicle highway fun
2-0
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T132
R T TIRE AUTO TIPTON Purchase Order No.
804 W JEFFERSON ST Terms
TIPTON, IN 46072 Due Date 12/21/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/21/20M 008583 $283.96
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
Date Officer