192438 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 355466 Page 1 of 1
ONE CIVIC SQUARE KEITH FREER
0 CHECK AMOUNT: $154.55
CARMEL, INDIANA 46032 1413 N. FAIRVIEW STREET
ALEXANDRIA IN 46001 CHECK NUMBER: 192438
CHECK DATE: 1217/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMO DESCRIPTION
851 5023990 154.55 OTHER EXPENSES
Papa Johns
Restaurant #1485
10598 North College Avenue,
Indianapolis, IN 46280
(317) 846 -7272
424978 11/29/2010 11:00am
InStore Order
Name: Keith
*:k 4 =#A* i l:f::f 4..i: *:t 4:1:1:
Restaurant Order 0002
Account xxxxxxxxxx4N�
Authorization 37605P
Reference 136992
Batch ID: 0
Order Amount: 57.45
Tax: 5.17'
Total Amount: 62.6
Mastercard: 6262
Tip:
Total:
Addtl Tender Amt: 0.00
Customer Signature
X
Customer Copy
Any delivery fee charged is riot a tip
for the Driver. Please reward your
driver with a tip for outstanding
service.
I agree to pay total amount according to
the card issuer agreement.
Thank You For Choosing
Papa Johns
THANK YOU FOR CHOOSING MCDONALDFQOS
750 E CARMEL DR
CARMEL IN
46032 -2806
1 THANK YOU
TEL# 317 846 9776 Store# 3894
TAX EXEMPT SALE
KS# 1 Nov.29'10 (Mon) 07:17
MFY SIDE 1 KVS Order 46
QTY ITEM TOTAL
15 EGG MCMUFFIN 32.85
15 SAUSAGE EGG MCMUFFIN 32.85
Subtotal 65.70
Tax 0.00
Take -Out Total 65.70
Cashless 65.70
Change 0.00
MER# 19244902
CARD ISSUER ACCOUNT#
SALE *411=
AUTHORIZATION CODE 46154P SEQ# 111085
MCDONALDS 3894
D
Right Store. Right NO.
1217 S. RANGELINE RD.
317- 896 -4818
YOUR CASHIER WAS VICCI
KVLU PLATES 1.75 T
KRO PI_STCUP PC 3.49 T
KRO ORNG JCE PC 3.49 F
KRO 20 MILK PC 2.68 F
KRO WHT MLK 1.89 F
KRO PPR NPKN 1.59 T
2 1.89
KRO DONUTS PC 3,78 F
3 1.89
KRO DONUTS PC 5.67 F
KRO DONUTS PC 1.89 F
TAX 0.48
TAX EXEMPTION 0.48
BALANCE 26.23
021 KROGER 4959
1217 S. RANGE_INE RD.
CARMEL IN 46032
Purchase
r.t. >:�n!r��4�r�
TOTAL: 26.2
REF4: 47496P
26.23
EXEMPTED SALES AMT 6.83
CHANGE 0.00
TOTAL NUMBER OF ITEMS SOLD 12
11129110 07:03am 959 83 5 tt
ENTER TO WIN
ONE OF 20
$100 GIFT CARDS
You are invited to complete a survey
about your recent visit to Kroger
Answer~ by internet
WWW.tellkroser.com
You need this receipt to respond.
Survey Entry Code 021 9?9
JOIN KROGER PLUS S BEGIN SAVING TODAY
YOU COULD HAVI_ SAVED $2.90
THANK YOU FOR SHOPPING KROGER
CUSTOMER SERVICE IS EVERYONE'S JOB.
LET ME KNOW HOW WE ARE DOING.
CHARL BECHEL, MANAGER
r:
VOUCHER NO. WARRANT NO.
ALLOWED 20
Keith Freer
IN SUM OF
$154.55
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
120 $2613 1 hereby certify that the attached invoice(s), or
1 20 $65.70 bill(s) is (are) true and correct and that the
112 $62.62
materials or services itemized thereon for
which charge is made were ordered and
received except
DEC 6 Awn
S' Y
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))
$26.23
$65.70
$62.62
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