187930 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
gI� ONE CIVIC SQUARE LEBANON TIRE AUTO SVC
CARMEL, INDIANA 46032 1310 W SOUTH ST CHECK AMOUNT: $105.00
LEBANON IN 46052 CHECK NUMBER: 187930
CHECK DATE: 7/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 123344 105.00 AUTO REPAIR MAINTEN
Ju 1 1510 12:32p p.1
L. FEE M C) T%41 T XFRE ^U r43 S%JIC
1 110 W SOUTH STREET
:LEBANON, IN 46052
(765)462 -5027 600
FEDE:AL TAX ID# 351145753
YIV =CE 07/15/10 07/15/10
1_-
12!:3-734-4- 12 =42 PM 12:42 PM
TERR: 7798
PAGE: 01 NONSIC-: 173531
BILL TO- CARMEL FIRE DEPT
BOB VANVCORST
2 CIVIC SQUARE
CARMEL, IN 46032
PHONE 1....... (317)664 -0958 I:XT. VEH YEAR /MAKE.
PHONE 2....... (317) 571 -2615 I XT. FAX VEHICLE MODEL
DATE REQUESTED 07/14/10 VEHICLE COLOR.
TIME REQUESTED LICENSE /STATE.
RETURN PARTS.. NO ODOMETR IN /OUT 000000 0
SA.LESNLkN...... 002 002 PRIOR INVOICE. 121801
P 0 NUMBER.... BOB VA.NVORS
A;-COUNT CCB TC CUST# TYDEISTATE
779800259 2 01 60259 4 IN
S -SM TFCH PRODUCT CODE BC lJY DESCRIPTION PARTS LBR /EXCESE LINE TOTAL
N2 017 046 -120 R ROAD SERVICE PER HR /PER MAN (REG TIME', .00 75.00 75.00
002 ON 046 -10.) R 425i65R225 =LOAT REPAIR .00 30.00 30.00
002 017 047 -100 R REAP. STEER.A3LE LATTER .00 .00 .00
REMEMBER TO SERVICE YOUR TRANSN SSIOV EVERY 1500 TO 300-00 MILES! v!E THANK Y0J FOR YOUR BUSINESS WITH US,
PARTS TOTAL......, CO
LABDR TOTAL. 105.00
CHARGED AMOUNT 105.00 SUB TOTAL........,, 105.00
X----------- T,AX.A3LE AMOUNT .00 SALES TAX.......... .CIO
CUS CMER AUTHORIZATION FOR -OTAL IL N x/ ic C E ir40 TA 9_ :Es 1 c] C3
BUYIRG PLAN... A CF PA`I- lENTS. 1 PAY START OA E 08:'10/10 DISCOUNT...... *MET*
SEE g ®E F= 0FZ MMF?®FZTA"T SAFE FY
ARM X M 43 N1 1.) WAFZF2AT8 -'Y X"V C>FZMA X40M
HAVE A QUESTION OR PROBLEM?
Ptease leII our stcre r—na gar We 43lue yaut cpinion as muan 35 yaur
business. Should you need additional assistance, cal our
CUSTOMER ASSISTANCE LINE 1 -800 321.2136
VOUCHER,NO. WARRANT NO.
ALLOWED 20
Lebanon Tire
IN SUM OF
1310 West South Street
Lebanon, IN 46052
$105.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# I Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 123344 43- 510.00 $105.00 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
11 1'9 2010
t /7 Z
u
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))
123344 $105.00
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