187488 07/07/2010 voided CITY OF CARMEL, INDIANA VENDOR: 360694 Page 1 of 1
ONE CIVIC SQUARE WESTFIELD AUTOMOTIVE LLC
0 CHECK AMOUNT: $7.94
CARMEL INDIANA 46032
d•,,e. 17534 WESTFIELD PARK ROAD
WESTFIELD IN 46074 CHECK NUMBER: 187488
CHECK DATE: 7/7/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 381271 7.90 REPAIR PARTS
Westfield Automotive Supply, Inc.
700 East Main Street P.O. Box 245 EE1 AUTO P 4f
Westfield, Indiana 46074 N AEMMPWFMWOMMNWMW Phone (317) 896 -5615 EAST MAIN STREET
Fax (317) 896 -1820 WESTFIELD, IN 46074
PLEASE SEND PAYMENT TO PO BOX 245 WESTFIELD
BILL TO CITY OF CARMEL- STREET DEPT
3400 W 131ST STREET STATEMENT
WESTFIELD, IN 46074 ;r tv M
ACCT #rSNI <,.PAGE
7995 0 1
I
DATE Pg TYPE$ REFEi�ENCE w Yb '...AMOUNT, a P O J,CHEGK/J Ez��a
05/29/2010 PRV Balance 0.00
06/23/2010 INV 381271 7.90
CURRENT PASnDUE F PAST`ED.t1ET9d7 ql t_V.
7.90 0.00 1 0.00 0.00
DATE 06/25/2010,� �T opt a [OiN e d� 7.90
,g
>.a""
TERMS No svc due 10thTMo t a IDaln�g 0.00
STORE 100006273 TR t 13D u e a 7.90
NAPA Auto Parts of Westfield.
700 E. Main Street Po Box 245 Westfield, In 46074 x'3:1:7.- 896 -5615
Please Remit To: H H Automotive Supply it 1212 W. Main St Lebanon, IN 46052 all
AGRICULTURAL EXEMPTION CERTIFICATE AR INDIANA DEPARTMENT OF REVENUE SALES TAX DIVISION agriculture! use
LIMITED WARRANTY PLEASE READ
I hereby certify under the penalties of perjury that the ectly personal properly purchased by the use of this exemption certificate will be
dir used in the direct production of agricultural products for resale.
Please examine these pads at once. Errors should be reported before using or installing. Returns "The factory warranty constitutes all of the warranties with respect to the sale of this itemlttems. The seller hereby expressly
O must be made within TEN DAYS and must be accompanied by this INVOICE NUMBER. This disclaims all warranties, either express or implied, including any implied warranty of merchantability or tire far a particular
property is sold to you with the definite understanding that it is purchased for resale, unless tax and the seller neither assumes nor authorizes any other person to assume for it any liability in connection with the
has been added to the price. ALL RETURNS SUBJECT TO 10% RESTOCKING CHARGE. Sale of this item /items. :z NO RETURN ON ELECTRICAL PARTS.
ACCT ~SOLD TO DATE" TIME STORE' EMP
r
7995 CITY OF CARMEL STREET DEPT 06 23 10109:50 100006273 25 361271 oil' ,F'
3400 W 131ST STREET PURCHASE ORDER ATTENTION
SR# WESTFIELD, IN 46074
41 TAX EXEMPTION:
AD TERMS; No svc due 10th Charge Salef
20 KEEP COPY INV DELIVERY: 1 of 1 u'
PART NUMBER LN. .r `;DESCRIPTION QUANTITY PRICE NET TOTAL
3L30OW NBH FHP POWERATED BELT 1.010 17.8 7.900C 7.90
fir
subto tai 7.90
25% RESTOCKIN FE Indiana Sale 740005 0.00
REMIT TO: 1 W AIN S:T 0.00
LEBANON, 0 —2324
TOTAL =:r-} Charge Sale:. 7.90
X
SIGNATU
ALL GOODS RETURNED MUST BEACCOMPANIED S THIS INVOICE
„f
V O U CHER N WARRA NO.
Westfield Automotive Supply ALLOWED 20
IN SUM OF
P. O. Box 245
Westfield, IN 46074
$7.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Membet
2201 381271 42- 370.00 $7.90 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
'Tl urs July 01, 201(
Uaocdl
Street CommissiAer
,d
uaG6
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))
06/23/10 381271 $7.90
f 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