186309 06/09/2010 s CITY OF CARMEL, INDIANA VENDOR: 355466 Page 1 of 1
ONE CIVIC SQUARE KEITH FREER
CARMEL, INDIANA 46032 1413 N. FAIRVIEW STREET CHECK AMOUNT: $199.61
ALEXANDRIA IN 46001 CHECK NUMBER: 186309
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO DESCRIPTION
1120 4110000 199.61 FULL TIME REGULAR
CTWQqc
C RW
PJA
IM A R K E T
6 04"M 0 Y 5 10
00-0001 002 CASH04
462000
DMRY X32¥'
GROCERY FS$3=19
ICERY 1- 43 2 1
DiUE $9.67
CREDIT END $9.67
1T7 COUNT 31
4
STRONGS ALEX MARKET
1212 N PARK AVE
ALEXANDRIA, IN 46001
05/0512010 20:08:37
Merchant ID: 000000000590759
Terminal ID: 01132015
218210413991
CREDIT CARD
SALE
CARD XXXXXXXXXXXX4628
INVOICE 0045
Batch 000486
Approval Code: 64257B
Entry Method: Swd ped
Approved: Online
SALE AMOUNT $9,67
CUSTOMER COPY
N CREDIT
S
EXPIRATION DATE
""Tom
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DATE. z.v.D000MENTNUMEER
0� b4 ►��J' 510- X4
'PRODDCT -OTY --PRICE AMOUNT'
R..L G K- E ,;�.�h REG. PLUS PREM. DIESEL
'MOTOR OIL :I I
RpFASER SI_
1
N FULL IPT O STATEMENT,
ICE E NUMBER STA
1
CREDIT AUTH. N0. SOLD BY TAX
TOTAL AMOUNT INCLUDES ALL APPLICABLE TAXES 1 I
EXEMPTTAXES
FORM 50656 REV. 7/83 WILLBB DEDUCTED ONSTATEMENT. .'T
J l g-
NC0m0|U's Corporation
l|u/)k vUu for aa1\nq at NcDonalU's
750 E CAKH[L DR
(AW. IN 46032
!|ANK YOU
QU01LL TEL# (317)846-977G
27 KS00 #ay.06'10(Thu)06:54
STORIU 5109 WRU K8l092449001
Order ����K U ��K�
IS EGG NCNUFFIN 220,
SAUSAGE [CG HCHUFFlN 21 .90
SUB [OlAL 54.75
FAKE OU[ TAX 4.93
59.68
'CARD l3CUER ACCOUNT A
SAL[ ***w*******4628
TRANSACTIOWA#OUNT 59.68
AUTH CODE 0531013 S[U0 5046
CASH TENDERED 0.00
CHANCE 0 AO
Papa Johns
Restaurant #1485
10598 North College Avenue
Indianapolis, IN 46280
(317) 846 -7272
380280 05/06/2010 11:15am
InStore Order
Name: Keith
*M. f *:4: *h.
Restaurant Order 0001
Account x.xxxxxx.xxxx4628 /0
Authorization is 031118
Reference 122064
Batch ID: 0
Order Amount: 100.00
Tax: 9.00
Total Amount: 109.00
_ 109.00
Tip:
Total:
Addtl Tender Amt: 0.00
Customer Signature
X
Customer Copy
I agree to pay total amount according to
the card issuer agreement.
Thank You For Choosing
Papa Johns
VOUCHER NO. WARRANT NO.
ALLOWED 20
Keith Freer
IN SUM OF
$199.61
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 41- 100.00 $199.61 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
JUN 4 2 o
f
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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 Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$199.61
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