184621 04/21/2010 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
•i:
CARMEL, INDIANA 46032 PO BOX 2856 CHECK AMOUNT: $115.50
KOKOMO IN 46904 -2856 CHECK NUMBER: 184621
CHECK DATE: 412112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 115.50 FOOD BEVERAGES
1ERICA
INVOICE
BEWRAGE BROOKSHIRE FIR MORTGAGE
INC. dba. BROOKSHIRE GbLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856 RR2903542 EXP. 07/13/10
765- 459 -3117
800 382 0675 Thursday Delivery
Fax: 765 457 7967
BEER W3409212
INVOICE DATE
j INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
l
04/22/10 413988 Dustin Smith 13 BOO 13
PESCRIPTION ICE AMOUNT
BASE April 5, 2010A
PROMO #0410A
PUMP $40/$33 REFUNDABLE
209 4 Bud Lt 24 Lse Can 16.40 a 6�• bd
760 1 Goose Wheat 312 1/6 BBL 55.00 30.00 85.00
Cases 4 1/4 Barrels I
TOTAL SALE 150.60
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 r
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00
.9270 IMPORT PUMP DEPOSIT 33.00
150.60
T OTALCR E D ITS Y CREDITS
Cash ❑EFT ❑Escrow Check Number
Driver B
7 V Received y
INVOICE
BEWRAGE BROOKSHIRE FIRST MORTGAGE
dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL- IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856
765- 459 -3117 RR290?542 _XP. 07/13/
800- 382 -0675 Thursday Deliver
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
04/15/10 413404 Dustin•Smith 13 904 13
RAC;F n nri 1 r ?!l1 nA
APPROVED BY THE STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL 2002 CHEC NO.
PAYABLE AT 7 -859 184397
FIFTH THIRD BANK
(iITY OF CiARIUIE INI�IANA NDIANAP0.L15 ;INDIANA 749
ONE CIVIC SQUARE :GENERAL:A000UNT DATE: 4/1412010
ra CARMEL, INDIANA 46031
AMOUNT
$180.45
CTS CTS
ONE EIORi ZfRO�
THIS WARRANT IS VOID TWO (2) YEARS AFTER
DECEMBER 31 OF THE YEAR OF ISSUE
To MIQ AMERICA BEVERAGE INC: CLERK- TREASURER
Thy pQ,gpX 2856
Order KOKOMOIN 46904 -2856
Of
11 L13 1 39711° 1:074908594 999i1193
Cases 3 1/4 Barrels 1
,i
a
MIN ES TOTAL SALE 205.35
10303 EMPTY AB 1/6 30.00 r T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 112 30.00 N
9230 PUMP DEPOSIT 33.00 K
9270 IMPORT PUMP DEPOSIT 33.00
?05.-7, CREDITS
Cash EFT Escrow Xcheck Number U c
Driver Received By
VOUCHER NO. WARRANT NO.
ALLOWE D 20
Mid America Beverage Inc.
IN SUM OF
P.O. Box 2856
Kokomo, IN 46904 -2856
$115.50
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1207 413988 42- 390.40 $115.50 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
Thursday, April 22, 2010
Director, Bro kshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
04/22/10 413988 Beer $115.5
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