165791 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
Q ONE CIVIC SQUARE HALSEN PRODUCTS CHECK AMOUNT: $770.86
CARMEL, INDIANA 46032 PO BOX 877
BELMONT MS 38827 CHECK NUMBER: 165791
CHECK DATE: 11/12/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
2201 4356001 0099428 -IN 770.86 UNIFORMS
i
PAGE: 1
HALSEN PRODUCTS COMPANY
P.O. BOX 877
BELMONT MS 38827
NATIONWIDE 1- 800 344 -6696
FAX 1 -800- 826 -8839 INVOICE NUMBER0099428 -IN
INVOICE DATE:10 /30 /2008
ORDER NUMBER:
ORDER DATE:
SALESPERSONO522
CUSTOMER N0b230327
SOLD TO SHIP TO
CITY OF.CARMEL STREET DEPT
ACCOUNTS PAYABLE DEPT BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
CUSTOMER P.O. SHIP VIA F.O.B. TERMS
BONNIE UPS Net, 30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
.BJM92K EAM, 576 576 0 0.580 334.08
BROWN JERSEY GLOVE
EACH 288 288 0 1.300 374.40
CHORE GLOVE. -YELL W
Net Invoice: 708.48
Less Discount:
THANK YOU FOR YOUR ORDER Freight: 62.38
Salea Tax: 0._00
I2lvoice Total 770.86
Less Deposit: 0.00
770.86
INVOICE BALANCE
,I
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))
10/30/08 0099428 -IN $770.86
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
VOUCHER N WARRANT NO.
ALLOWED 20
HMsen Products
IN SUM OF
O. Box 877
Belmont, MS 38827
$770.86
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
2201 0099428 -IN 43- 560.01 $770.86 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
Friday, November 07, 2008
Street Corrw4aioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund