192932 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 363869 Page 1 of 1
ONE CIVIC SQUARE SCOTT TOWNSEND
0 CHECK AMOUNT: $99.50
CARMEL, INDIANA 46032 1407 SOUTH H STREET
ELWOOD IN 46036 CHECK NUMBER: 192932
CHECK DATE: 12/15/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 8000326 99.50 UNIFORMS
TCTOR
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2375 EAST PLEASANT ST., RT. 37
NOBELSVILLE, IN 46060
317 -776 -1883
Ticket :58465
Date: 12/6/10 Time: 10:29 AM
Store: 624 Resister: 1
Cashier: 00115036
Cusiomer Name: CARMEL STREET DEPT
Phone 4: 3177332001
SPECIAL ORDER PO
8000326
Vendor: CARHARTT SEASONAL MD
Vendor Id: 512855
Vendo Item 4 Qty Price Amount
92x34_
222220 Special Order- Article
R27BRN 1 99.50 99.50 T
Clothing
567 8601004 SCO Freight
1 0.00 0.00 E
Open Item Total 99.50
Pay ment Tgpe Amount
Special Order Deposit 99.50
12/6/10
Special Order Total 99.50
Deposit /Payment: 99.50
Balance Due: 0.00
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2375 EAST PLEASANT ST., RT. 37
NOBELSVTL.1 -E, IN 96060
317 -776 -1883
Ticket: 58465
Date: 12/6/10 Time: 10 :28 AM
Store 624 Registers 1
Cashier: 00115036
Business Customer: CARMEL STREET DEPT
3 W 131ST ST
Westfield, IN 46074 8267
317 -733 -2001
Item Qty Pric Amount
92x34
Special Order Article
222220 1 99.50 0.00 T
R27BRN
Clothing
Special Order ID S106242100335
8601009 SCO Freight
567 1 0.00 0.00 E
Special Order- ID S106212100335
Special Order Deposit
565 1 99.50 39,.50
Special Order TD S06242156335
Subtotal 99.50
Tax 0,00
Total 99.50
Visa 99.50
XXXXXXXXXXXX2629
Auth #:02596B
Change 4_- 0.00
I agree to parr the above amount according' -to'
'my card i5SUer agreement,
Tax Exempt Information
Name: CARMEL STREET DEPT
Address: 3400 W 131ST ST
City/St: Westfield, IN
Zip Code: 16074 8267
Phone: 317 3-33 -200
Tax Exempt Reason: Government Agencies
Expiration Date
Tax Exempt Holder:
Under penalty of PerJury, signee declares
the items he /she has Purchased the
applicable Products exempt from sales and
use tax, has been dune so with the
understanding that under- state law he /she is
attesting to having a valid exemption for
the Purchased items. Additionally, the
customer attests that all information he /she
has provided is accurate. Any willfully
false representation of exemption or
customer information is subject to Penalty
under state law.
This transaction consists of one or more
items exempt from state sales or use tax.
Before completing this transaction you
attested that the information Provided,
including name, address, and sales fax
exemption number (if necessary), is
accurate. In addition you have declared that
you legally have a rishl to Purchase the
above items exempl from'sales and use taxi
for the reason indicated as defined by this
State's laws and requ.lations,
Call 800 968-0734 within 7 days
to complete a survey and be entered
in a monthly drawins for a chance
to win a $2500 shoppins spree.
(Awarded as Gift Card) Ends 9/30/2011
For complete details or to participate
without Purchase or survey, so to
TractorSupplu .com /cusiomersurvey
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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))
12/06/10 8000326 $99.50
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
VOUCHER NO. W NO.
ALLOWED 20
Scott Townsend
IN SUM OF
c/o Carmel Street Department
$99.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 8000326 43- 560.01 $99.50 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
U ctic/
Fay rid December 10, 2010
'Zy
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund