190578 10/06/2010 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CHECK AMOUNT: $96.90
CARMEL, INDIANA 46032 PO Box 2856
KOKOMO IN 46904 -2856
�a CHECK NUMBER: 190578
CHECK DATE: 10/6/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 96.90 FOOD BEVERAGES
MIDAMERICA INVOICE
BEVERAGE BROOKSHIRE .FIRST MORTGAGE
dba,BROOKSHIRE GOLF CLUB
INC. 12120 BROOKSHIRE PARKWAY
-r te 2755 Commerce Dr. CARMEL I N 46032
P.O. Box 2856
Kokomo, IN 46904 -2856 H HZVU6 2
765- 459 -3117
800 382 -0675 Thursday Delivery
Fax: 765- 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
10' /07 /ic) 429453 Dustin Smith 13 $CO 13
P R OD UCT
AMO
QUANTITY
•D
BASE September 13,2010A
PROMO #01010A
PUMP $40/$33 REFUNDABLE
209 3 Bud Lt 24 Lse Can 16.80 50.40
225 1 Bud Lt 1 /4.2BL 46.50 30.00 76.50
Cases 3 .1/4 Barrels 1
PROD CODE QTY DESCRIPTION PRICE AM• 126.90
TUTALSALE
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 112 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00
126.90
BMW
X� Y
CREDITS
Cash EFT Escrow kheck Number
//U
Driver Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF
P.O. Box 2856
Kokomo, IN 46904 -2856
$96.90
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# l Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 429453 42- 390.40 $96.90 i 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, October 07, 2010
Director, Brooks 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. 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))
10/07/10 429453 Beer $96.90
1 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