193495 01/05/2011 CITY OF CARMEL, INDIANA VENDOR: 236175 Page 1 of 1
ONE CIVIC SQUARE PARKSIDE ANIMAL HOSPITAL CHECK AMOUNT: $960.00
CARMEL, INDIANA 46032
12962 PUBLISHERS DRIVE
FISHERS IN 46038 CHECK NUMBER: 193495
CHECK DATE: 1/5/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4357600 27110 131038 960.00 DOG FOOD
PARKSIDE ANIMAL HOSPITAL Account: 322
12962 Publishers Drive Invoice: 131038
Fishers, IN 46038 Date: 12/23/2010
(317) 849 -1440 Time: 10:35 AM
Page: 1
Carmel Police De Patient: BEN Age: 3
3 Civic Square Species: Canine Sex: ML
Carmel IN 46032 Breed: German Shepherd Tag: 85342
Color: Black Tan Weight: 81.70
Doctor: Mike Havens, D.V.M.
Phone: (317)
ServicelItem Qty Price Amount i
lams Large-Breed Adult 44# 24.00 40.00 960.00
Tax 0.00
Net Invoice 960.00
Previous Balance 262.17
Payment 0.00
Balance Due V 1222.17.
Reminders: Aug. 26, 2012 Rabies Vaccine 3 Year
Sept. 23, 2011 Annual Wellnes Physical Exam
Sept. 23, 2011 Dist- A2P -Parvo Annual
Sept. 23, 2011 Leptospirosis vaccine annual
Sept. 23, 2011 Bordetella Vacc Annual
Sept. 23, 2011 Heartworm Test Occult
Sept. 23, 2011 Fecal Exam Annual
Sept. 23, 2011 Interceptor 51 -100# 12 tablets
Thank You
We endeavor to provide quality care with a personal touch!
INDIANA RETAIL TAX EXEMPT PAGE
C ity �1.� Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
A Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 9
3�MCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELSAND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
December 13 2010 F dog food
VENDOR SHIP
Parkside Animal Hospital. TO City of Carmel Police Department
3 Civic Square
Fishers, IN Carmel IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNPT PRICE EXTENSION
24 bags dog food 40°00 960.00
k,' 4�t`
U 4ke z.
•a°ac• 9•Dry
lr {{}may c 4'b
f3 1 41/.".
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 576 animal services PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID..
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED, ORDERED BY `ff�f 9
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief Of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 27110 A.P.V. COPY SIGN AND RETURN TO CLERK OFFICE
VOUCHER NO.__— WARRANT NO._
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 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
20
Signature
Title
Cost distribution ledger classification it
claim paid rnotor vehicle highway fund
Prescribed by Stale Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
Total
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
VO HER NO. WARRANT NO.
ALLOWED 20
trkyi A nimal Hospital
IN SUM OF
12962 Publishers dr
Fishers, IN 46038
960.00
ON ACCOUNT OF APPROPRIATION FOR
police general f und
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
27110 131038 576 960.00 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
December 9, 2010
A nnure
ief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund