181774 02/02/2010 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
1i
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
k iii J CARMEL, INDIANA 46032 PO BOX 2856 CHECK AMOUNT: $68.40
3 KOKOMO IN 46904 -2856 CHECK NUMBER: 181774
CHECK DATE: 2/2/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 68.40 FOOD BEVERAGES
1111113eANIERICA INVOICE
BEVERAGE BROOKSHIRE FIRST MORTGAGE 4.0
INC. dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY Fe -791
1
NE00 11111611111615111662123 2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904-2856
765 RR2903542 EXP. 07/13/10
800 Thursday Delivery
Fax. 765-457-7967
7...r
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
f
02/04/10 406975 Dustin Smith 13 800 13
PRODUCT
QUANTITY
I DESCRIPTION
CODE I PRICE 1 DEPOSIT AMOUNT
BASE February 1, 2010A
PROMO #0209A
PUMP $40/$33 REFUNDABLE
109 3 Budweiser 24 Lse Can 16.40 49.20
209 3
Bud Lt 24 Lse Can 16.40 49.20
Cases 6
r,
PROD. CODE QTY DESCRIPTION PRICE AMOUNT
TOTAL SALE 98 40
10303
i EMPTY AB 1/6 30 00 j...44,C,C T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00 K
9270 IMPORT PUMP DEPOSIT 33.00 98 40
RETURNS r TOTAL CREDITS 101.% y
CREDITS
0
E Cash 0 EFT III Escrow E!I Number //7797
u
A TOTAL DUE
Driver -1, Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF
P.O. Box 2856
Kokomo, IN 46904 2856
$68.40
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 406975 42 390.40 $68.40 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
Thursday, February 04, 2010
Director, Brook' 'e Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
1
Prescribed by State Board of Accounts City Form No 201 (Rev 199`.
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))
02/04/10 406975 Alcohol $68.4
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