190971 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 00351248 Page 1 of 1
0 ONE CIVIC SQUARE JEFF STEWART
CARMEL, INDIANA 46032 C/O STREET DEPT CHECK AMOUNT: $4.47
C/O STREET DEPT CHECK NUMBER: 190971
CHECK DATE: 10/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 39914 4.47 REPAIR PARTS
TBMTOR
18|60 U.S. 31 NORTH
WE3TFIGLU, IN 16074
317-867-3505
Ticket: 399)q
Date: 9/30/0 Time: 11:22 HM
Siore: 131 Register-: 2
Cush/c,: 00321951
Coyinnm': XXX CHRwEL 3TREET 0EYT
p»n^e U� 3177332001
Company: CARnEL STREET DEPT
Item _--__----8kiPr- i ceL---_ Amount
SlHwUnRV |05E wEwUEx 3/8 3/8x8
7109012 1.1� 1.49 E
57RwU8VO HOSE MENDER 3/8 3/8H8
2109012 1,19 1.19 E
STANDARD HOSE MENDER 3/8 7 1/0|B
2109012 1.49 1.19 E
slit) +oiu\ 4.17
Tax 0.00
Total 1,*7
Visa 1.17
XY3KYXXXXKKX9163
ovm 0:05721C
[hanse 0.00
I oore to pev +he above unov^t occurUmy to
my co,U issue, asree*po|
Tax Exempt |^form^|/un
Name: XXX CHRmEL STREET DEPT
HuUre,,: 3100 W }J|ST ST
Ci|y/Sf: WESTFIELD, IN
Zip Code: 16071-8267
Phone: 317-733-2001
Tax Exempt Reason: Gv"e,^meo/ ooe^cieo
E,pi,o|/u^ Date:
'fax Exempt Holder
UoUe, pe^a|(y of pp,jvry, s^nnee declares
the items he/She has ,Ur-chased the
applicable prodvci, exempt From sales and
use |vx. has heo^ done so with the
v.`ders|n.`dmy |ha/ o^de, o|o|e 1a° lie/she is
6+|os/m9 to »nvmy a valid vxenp|i^o f or-
the "vcuaseo /|^na odJi//v^o|/y. /he
cvs|umer o|icsto No/ all /nrn,nufio^ |e/she
has provided is accvrv/^ Any w/|/ru|ly
false ,epr,aemoi/o^ or e^enptio^ or
cvs|one, information is subject t p
under stale |^w.
Tract®rSupplyoc ®m
Trac$®rSupplyoc ®m
Tract®rSupplyoc ®m
w
Tract®rSupplyoc ®m
Tract®rSupplyoc ®m
VOUCHER NO. WARRAN N O.
ALLOWED 20
Jeff Stewart
IN SUM OF
c/o Carmel Street Department
$4.47
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# 1 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 39914 42- 370.00 $4.47 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
1lJ {1[ l Thurs� y, Oci er 07, 2010
I r l i C l9. R
Street Commissioner
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))
09/30/10 39914 $4.47
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