191224 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC CHECK AMOUNT: $1,455.76
CARMEL, INDIANA 46032 PO BOX 1106
NOBLESVILLE IN 46061
CHECK NUMBER: 191224
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231400 GTO18047 1,455.76 GASOLINE
SALE 3421 DATE 10115/10 14:34:42
COUNT: START 0.0 END 244.6
GROSS DELIVERY 244.6 GALLONS
4040 DIESELEX ULS UN DISTILLATI
#o MULTIPLE DELIVERIES AT SITE v1
SALE 1797 DATE 10/15/10 14:37:02
COUNT: START 0.0 END 3313.4
GROSS DELIVERY 313.4 GALLONS
4917 UNLEADED GAS GOVGASOLINE i
x# MULTIPLE DELIVERIES AT SITE*
VNILTON COUNTY CO-OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: ST GARY TEETERS'
Customer: 0000026761 Invoice B: GT 018947
BROOKSHIRE GOLF CLUB Date: 10/15/2010
CITY OF CARMEL Time: 14:39
12120 BROOKSHIRE PKWY
CARMEL, IN 46033
Tres Terns Description' Iteg D Description Legend Quantity Unit Price Itee Total
01 NORMAL 104817 UNLEADED GAS GOV'T E 313.4009 2.38000 745.89
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REQUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
(I.V.D.) ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P.S.1 MAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST
THROUGH SEPTEMBER 15TH.
Federal Road Tax 0.09000 9.00
State Road Tax 0.18000 56.41
01 NORMAL 154040 DIESELEX ULS UN 19 E 244.6980 2.74090 670.20
01 NORMAL 194070 PETRO VOLUME DISCOUN 558.0000 0.03000 -16.74
Legend: Invoice Subtotal: 1,455.76
Metered, T= Taxable, Entered by Hand Indiana Sales Tax On: 9.00 0.00
Invoice Total: 1,455.76
Wh4ikG.`--PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
il,' 1NA ING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT V0-424- 0 HE
AR IATE YOUR BUSINESS!!!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hamilton County CO -OP
IN SUM OF
P.O. Box 1106
Noblesville, IN 46061
$1,455.76
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT41TITLE AMOUNT
Board Members
1207 GT 018047 42- 314.00 $1,455.76 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
Wednesday, October 20, 2010
Director, Brooks re 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))
10/15/10 GT 018047 Fuel $1,455.76
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