188827 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $298.16
BELMONT MS 38827 CHECK NUMBER: 188827
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 R4356001 21419 0107623 -IN 298.16 GLOVES
VOICE PAGE: 1
HALSEN PRODUCTS COMPANY
P.O. BOX 877
BELMONT, MS 38827
NATIONWIDE 1 -800- 344.6686
FAX 1- 800 826 -883s INVOICE NUMBER: 0107623—IN
INVOICE DATE:
8/3/2010
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ACCOUNTS PAYABLE DEPT BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
CUSTOMER P.O. SHIP VIA
BONNIE UPS Net 30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
13JM92K EACH 432 432 0 0.620 267.84
BROWN JERSEY GL VE
Net Invoice; 26-7-84—
Less Discount: 0.00
THANK YOU FOR YOUR ORDER Freight: 30.32
Sales Tax: 0.00
Invoice Total: 298.16
Less Deposit: 0.00
•9 8-1
INVOICE BALANCE
VOUCHER NO_. WARRANT NO.
ALLOWED 20
Halsen Products
IN SUM OF
P. O. Box 877
Belmont, MS 38827
$298.16
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
21419 0107623 -IN 43- 560.01 $298.16 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 �Au/gust 12, /1' 2010
4�
UU/
r V
S tfiB COmmi SSiigner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 261 (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))
08/03/10 01 07623 -IN $298.16
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