HomeMy WebLinkAbout198229 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH BROOKSHIRE GOLF COURT
CARMEL, INDIANA 46032 C/O PAM LISTER CHECK AMOUNT: $39.98
CHECK NUMBER: 198229
CHECK DATE: 6/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4359500 89294 39.98 PETTY CASH
YC®
TractorSupply.com
18160 U.S. 31 NORTH
WESTFIELD, IN 46074
317 -867 -3505
Ticket: 89299
Date: 5/2E;/11 Time: 8:26 AM
Store: 431 Register-: 2
Cashier: 00305398
Customer-: Russell Pickett
Phone tl: 7,174201676
Item_ Qt y_ Pri Amount
HSK BELT /8X62IN
9461622 1 19.99 19.99 E
HSK BEl_; 5/8X62IN
9961022 1 19.99 19.99 E
Subtotal 39.98
Tai: 0.00
To t a l 39.98
Cash 50.00
Change
—re
Cash (10.02)
Tax Exempt Information
Name: Russell Pickett
Address: 12120 Berkshire Parkway
City /St: Carmel, IN
Zip Code: 46032
Phone: 317- 420 -1676
Tax Exempt Reason: Non- Profit /Exempt Org
Expiration Date:
Tax Exempt Holder:
Under Penalty of per jury, signee declares
the items he /she has purchased the
applicable Products exempt from sales and
use tax, has been done so with the
understanding that under state law he /she is
attesting to having a valid exemption fur-
the Purchased items. Additionally, the
customer attests that all information he /she
has provided is accurate. Any willfullg
false representation of j r
customer informa.irun is subject to penalty 1
Prescribed by State 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 3 9.
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. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
420 &cc_,2
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
12 0 0D -0 9 ,C 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
J L�acQ 20
Sign pre
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund