160890 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
0 ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC CHECK AMOUNT: $5,088.92
CARMEL, INDIANA 46032 PO BOX 1106
NOBLESVILLE IN 46061 CHECK NUMBER: 160890
CHECK DATE: 6/25/2008
DEPARTMENT ACC OUNT PO NUM INVOICE NUMBER A DESCRIPTION
905 4231300 012506 1,430.75 ID ESEL FUEL
905 4231300 012607 1,554.56 ✓pIESEL FUEL
`905 4231300 104187 138.81IESEL FUEL
905 4231300 104188 -37.33 DIESEL FUEL
?201 4238900 400635 168.75JOTHER MAINT SUPPLIES
2201 4238900 69077 21.88/OTHER MAINT SUPPLIES
1115 4231300 BB006640 420.74 IESEL FUEL
2201 4231300 GTO12732 1,668.38�IESEL FUEL
STATEMENT
n Grain Merchandising 773 -2685 Amount
P x O u a d y Grain Terminal 773 -2599 Enclosed.
Horton 758 -4463 PAGE 1
COOPERATIVE ASSOCIATION INC Noblesville Petroleum /Plant Food 776 -4143 08
SEND INQUIRIES TO:
PO Box 1106' Noblesville, Indiana 46061 PAY THIS AMOUNT $6, 863.94
(317) 773 -0870 Fax (317) 776 -4149
0000028761 BROOKSHIRE GOLF CLUB CUSTOMERS IN TIPTON AND ATLANTA CAN NOW CALL TOLL FREE
CITY OF CARMEL THE NEW NUMBER IS 765- 675 -2538
12120 BROOKSHIRE PKWY
CARMEL IN 46033
L _j PLEASE RETURN THIS PORTION WITH REMITTANCE
04/30/08 BALANCE FORWARD 4,054.77
05/14/08 012506 010 INVOICE 1,430.75 5,485.52
202.9000 GAL UNLEADED GAS 3.6640 743.42
177.8000 GAL DIESELEX ULS 3.9300 698.75
380.7000 -EA PETRO VOLUME DISCOU .0300 11.42-
05/15/08 104187 010 CREDIT MEMO 138.81- 5,346.71
527.4000 GAL UNLEADED GAS 3.2640 1721.43
527.4000 -GAL UNLEADED GAS GOV' 3.0800 1624.39
INVOICE 12262
227.0000 GAL UNLEADED GAS 3.5140 797.68
227.0000 -GAL UNLEADED GAS GOV' 3.3300 755.91
INVOICE 12377
O5 /15 /08 104188 010 CREDIT MEMO 37.33- 5,309.38
202.9000 GAL UNLEADED GAS 3.6640 743.42
202.9000 -GAL UNLEADED GAS GOV' 3.4800 706.09
INVOICE 12506
05/29/08 012607 010 INVOICE 1,554.56 6,863.94
226.2000 GAL UNLEADED GAS GOV' 3.7800 855.04
165.8000 GAL DIESELEX ULS 4.2900 711.28
392.0000 -EA PETRO VOLUME DISCOU .0300 11.76
V 0 L/
CREDITTERMS ENTIRE ACCOUNT IS SUBJECT TO AGED ANALYSIS OF BALANCE
000p�R MONTH ANNUAL RATE 00 CURRENT 1 30 DAYS 31 90 DAYS OVER 90 DAYS PAY THIS AMO
FINANCE CHARGE OF
IF PAYMENT NOT RECEIVED BY: 06/30/08 2985.31 3878.63 .00 .00 6,863.94
EXPLANATIONS:
1. The monthly period is from the first day of the month to the last day of the month.
2. "Payment now due" is the portion of the total that will be due on or before the due
date. Any account not paid by this date is considered "past due".
NOTICE TO CUSTOMER: If you pay the New Balance on or before the Due Date
there will not be a finance charge.
A Finance Charge will be added when the account becomes past due. The due date
or time period of the credit terms is on the front side of this statement. To avoid a
FINANCE CHARGE, the Payment Now Due must be received on or before Due Date.
FINANCE CHARGE is computed by using the Periodic Rate (per month) applied to
amount pas-t duQas-off the closing -date, or the Minimum Finance Charge, as shown.
The Annual Finance Charge rate is shown in the Annual Rate box. The finance,
charge is made as of the closing date.
IN CASE OF ERRORS OR INQUIRIES ABOUT YOUR BILL: Send your written inquiry
to the address shown on the front of this statement so that we receive it within 60 days
after the bill was mailed to you. Your written inquiry must include: 1. Your Name and
Account Number (if any): 2. A Description of the Error; and 3. The Dollar Amount of
the Suspected Error. You remain obligated to pay the parts of the bill not in dispute.
During that same time, we may not take any action to collect disputed amounts or
report disputed amounts as delinquent.
This is a summary of your rights; a full statement of your rights and the creditor's
responsibilities under the Federal Fair Credit Billing Act will be sent to you both upon
request and is response to a billing error notice.
Noblesville -Office Horton Feed Grain Gray Storage
H County 773 -0870 758 -4463 776 -4155
Grain Terminal Noblesville Petroleum Merchandising
COOPERATIVE ASSOCIATION, INC. 773 -2599 Plant Food Station 773 -2685
776 -4143
16222 Allisonville Road P O. Box 1106 Noblesville, Indiana 46061
s BROOKSHIRE GOLF CLUB (CREDIT MEMO)
L CITY OF CARMEL
TT 121 BROOKSH I RF_ PKWY
CARMEL IN 46033
ACCOUNT NO. PURCHASE ORDER NO. SALES TAX LICENSE NUMBER SALESMAN PAYMENT DUE ON TERMS: DAY OF THE INVOICE NO. DATE PAGE
MONTH FOLLOWING MONTH OF PURCHASE. �7� �7, O
28761 GT RETUNVOICE.
I TE M S
MUST BE ACCOMPANIED BY 104188 0 5/ 15/08 1
•D AMO
UNLEADED GAS 104017 2 02.9000 GAL 3.3000 669.57
FEDERAL EXCISE TAX 2:02::.9000 GAL 0.1840 37.33
STATE EXCISE TAX 202.9000 GAL 0.1800 36.5`
UNLE=ADED GAS GOV' T 104817 202.9000— GAL 3. 3000 669.57
STATE EXCISE TAX 202.9000 GAL 0.1800 36.
For Government Use Only
INVOICE 12506
All accounts subject to court RECEIVED IN GOOD ORDER AMOUNT PAID CASH DISCOUNT
costs and attorney fees if legal 0
action is necessary to collect CUSTOMER
said amount. SIGNATURE v7 a 3
.:l
Emergency Contact: LATE CHARGE PER MONTH PER ANNUM
Chemtrec 1 -800- 424 -9300 CUSTOMER COPY
Noblesville -Office Horton Feed Grain Gray Storage
773 -0870 758 -4463 776 -4155
i Hamilton County
Grain Terminal Noblesville Petroleum Merchandising
COOPERATIVE ASSOCIATION, INC. 773 -2599 Plant Food Station 773 -2685
16222 Allisonville Road P. O. Box 1106 •Noblesville, Indiana 46061 776 -4143
o BROOKSHIRE GOLF CLUB (CREDIT MEMO>
L CITY OF CARMEL
D _6
T 12120 BROOKSHIRE PKWY
O CARMEL IN 4E033—
ACCOUNT NO. PURCHASE ORDER NO. SALES TAX LICENSE NUMBER SALESMAN TERMS: INVOICE NO. DATE PAGE
-f PAYMENT DUE ON THE LAST DAY OF THE �7� 0 5/15/ 0
G8 F i. GT RE
ITEMS M ST�BE ACCOM ED SBY 1 04 1 87 8 1
THIS INVOICE.
OD e
UNLEADED GAS 104017 527. 4000 GAL 2. 9000' 1529.46—
FEDERAL EXCISE TAX 527. 4000 GAL 0.1840 97.04—
STATE EXCISE TAX 557.4000' GAL 0.1800 94.93
UNLEADED GAS GOV' T 104817 527.4000— GAL 2.9000 1529.46
STATE EXCISE TAX 527.4000— GAL 0.1800 94.93
For Government Use Only
I
INVOICE 1 21:.62
U NLEADED GAS 104017 227.0000 GAL 3.1500 715.05
FEDERAL EXCISE TAX 227. 0000 GAL 0.1840 41.77--
STATE EXCISE 'TAX 227.0000 GAL 0.1800 40.86—
*CONTINUED
All accounts subject to court RECEIVED IN GOOD ORDER AMOUNT PAID CASH DISCOUNT
costs and attorney fees if legal
action is necessary to collect CUSTOMER
said amount. SIGNATURE
Emergency Contact: LATE CHARGE PER MONTH PER ANNUM
Chemtrec 1 -800- 424 -9300 CUSTOMER COPY
Noblesville -Office Horton Feed Grain Gray Storage
773 7 0870 758 -4463 776 -4155
ton COM
H Grain Terminal Noblesville Petroleum Merchandising
COOPERA'T'IVE ASSOCIATION, INC. 773 -2599 Plant Food Station 773 -2685
776 -4143
162A ffi bgyilg,F Cf,k,p O Win 1 jP6 "jttgille, Indiana 46061
S h(t l]lfl L L1J i (CREDIT MEMO>
L CITY OF CARME:L
D
T 121 BROOKSHIRE PKWY
0 CARMEL IN 4E033—
ACCOUNT N0. I PURCHASE ORDER NO. SALES TAX LICENSE NUMBER SALESMAN TERMS: INVOICE NO. PAGE
p �7 f� YMENT DUE ON THE LAST DAY OF THE
NTH `8l 61 VT REOTURNFOE M M ST n BE ACCCOM S BY 1.04187 05/15/12018 1
THIS INVOICE.
PR ODUCT
I
UNLEADED GAS GOW T 104817 227.0000-- GAL 3.1500 715.05
STATE EXCISE TAX 227.0000 GAL 0.1800 40.8E
For Government Use Only
INVOICE 12377
8 1
I
All accounts subject to court RECEIVED IN GOOD ORDER AMOUNT PAID CASH DISCOUNT 71 378. costs and attorney fees if legal
action is necessary to collect CUSTOMER
said amount. SIGNATURE 8 1 I+ I
Emergency Contact: LATE CHARGE PER MONTH PER ANNUM
cnemtrec 1- 8 00 -424-9300 CUMMER COPY
E
SALE 9211 DATE 05125108 16:17:06
k COUNT: START 0.0 END Ir.
GROSS DELIVERY 165.9 GALLONS
4640 DIESELEX ULS DISTILLATI
MULTIPLE DELIVERIES AT SITE
SALE 4933 DATE 05/29/08 16:20:40
COUNT: START 0.0 END 226.2
GROSS DELIVERY 226.2 GALLONS
4817 LM-FADED 6.4S GOVGASOLINE 1
IIJLTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO-OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: BT GARY TEETERS
Customer: 0000028761 Invoice GT 012607
BROOKSHIRE GOLF CLUB Date: 5129/2008
CITY OF CARMEL Time: 16:23
12120 BROOKSHIRE PK'NY
CARMEL, IN 46033
Tres Terms Description Item Description Legend Quantity Unit Price !tee Total
01 NORMAL 104817 UNLEADED GAS GOV'T E 226.2000 3.60000 814.32
f
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REQUIREMENTS FOR P.EFORMULATED"GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRO'DUC
tI.V.D.i ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P. S.1 MAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST
THROUGH SEPTEMBER 15TH.
Federal Road Tax 0.00000 0.00
State Road Tax 0.18000 40.72
01 NORMAL 154040 DIESELEX ULS E 165.8000 4.29000 711.28
01 NORMAL 194070 PETRO VOLUME DISCOUN 392.0000 0.03000 -11.76
Legend: Invoice Subtotal: 1,554.56
E= Metered, T= Taxable, Entered by Hand Sales Tax On: 0.00 0.00
Invoice Total: 1,554.56
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING DR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1- 800 424 -9300 WE
APPRECIATE YOUR BUSINESS!,!
f
f
t SALE 9125 DATE 05/14/03 16:09:22
COUNT: START 0.0 END 173.0
GROSS DELIVERY 173.0 GALLONS
4040 DIESELEX ULS DISTILLATI
MULTIPLE DELIVERIES AT SITE
SALE 4874 DATE 05 /14108 16:12:23
COUNT: START 0.0 END 202.9
GROSS DELIVERY 202.9 GALLONS
4017 UNLEADED GAS GASOLINE 1
ff MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY M-OP
PO BOX 1106
NOBLESVILLE, IN 46061
5
CHARGE INVOICE
Driver: GT GARY TEETERS
Custooer: 0000 8761 Invoice GT 012506
BROOKSHIRE GOLF CLUB Date: 5/14/2008
CITY OF CARMEL Time: 16:15
i
12120 BROOKSHIRE PKWY
CARREL, IN 46033- i
i
Tros Terms Description Item Description Legend Quantity Unit Price Itea Total
01 NORMAL 104017 UNLEADED GAS E 202.9000 130000 '669.57
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REQUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC
(I.V.D.) ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P.S.I MAX. RVP GASOLINE DURING THE MONTHS OF MAY IST
THROUGH SEPTEMBER 15TH.
Federal Road Tax 0.18400 37.33
State Road Tax 0.18000 36.52
01 NORMAL 154040 DIESELEX ULS E 177.8000 3.930PtI '698.75
01 NORMAL 194070 PETRO VOLUME DISCOUN 380,7000 0.03000 -11.42
Legend: Invoice Subtotal: 1430.75
E T= Taxable, Entered by Hand Sales Tax On:. 0.00 0.00
Invoice Total: 143@.75
C
WARNING PETROLEUM PRODUCTS ROT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES-NOT SOLD FOR
ILLUMINATING OR CLEANING PURPbSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1- 800 424 -9300 WE
APPRECIATE YOUR BUSINESS!!!
R.
i
i
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
119835 Purchase Order No.
Hamilton County Co -op
PO Box 1106 Terms
Noblesville IN 46060
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
S- -1 Y-0 Q I d ST) 75,
5_,1S-QS /0 8 13 Y, hl
S /5 -U� /O V/ 3 7• 33
S d 9-0S /5_S y SZ
Total o?
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 NO. WARRANT NO.
ALLOWED 20
119835 IN SUM OF
Hamilton County Co -op
PO Box 1106
Noblesville IN 46060
0? ZD /2
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
QS' 2 /3 V30, 7,5 bill(s) is (are) true and correct and that the
U e7 /30, of materials or services itemized thereon for
O v/ s which charge is made were ordered and
S S received except
to 20
n�tureA
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
f
t
SALE 9,320 DATE 08117108 09:40:30
COUNT: START 0.0 L1 40 388.9
s
GROSS DELIVERY 368.9 GALLONS
4040 DIESELEX U!.S DISTIL LAT1
MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO -OP
PO BOX 1108
NOBLESVILLE, IN 46@61
i
f CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000031175 Invoice p: GT 012732
CARMEL STREET DEPT Date: 6/17/2008
3400 W 131ST STREET Time: 09:49
WESTFIELD, IN 48074`
f
Trms Terms Description Item Description Legend Quantity Unit Price Item Total
01 NORMAL 154040 DIESELEX ULS E 388.9000 4.29000 1688.38
Legend: Invoice Subtotal: 1,888.38
E= Metered, T= Taxable, *centered by Hand Indiana Sales Tax On: 0.00 0.00
4 Invoice Total: 1,688.36
t
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1- 800-424 -9300 WE
APPRECIATE YOUR BUSINESS
1
4
E
t
I
Z
i
Prescribed by State Board of Accounts City Form 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))
06/17/08 GTO12732 $1,668.38
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 NO. WARRANT NO.
Hamilton Co. Co -op ALLOWED 20
IN SUM OF
P. O. Box 1106
Noblesville, IN 46061
$1,668.38
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 GTO12732 42- 313.00 $1,668.38 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
Thursday, June 19, 2008
Street do Amissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
y
I
HAMILTON COUNTY CO—OP
16222 ALLISONVILLE RD
NOBLESVILLE, IN 46060
CHARGE INVOICE i
Driver: BB BRIAN BARNETT
Customer: 0000031182 Invoice: BB 006640
CARMEL COMMUNICATIONS Date: 6/10/2008
31 1ST AVE. S.W. Time: 10:42
CARMEL, IN 46032
Tres Terms Description Item Description Legend Quantity Unit Price Item Total Tank %Full /Gal
01 NORMAL 154040 DIESELEX ULS 4 94.0000 4.21000 395.74 0
01 9A1, 6240 SPECIAL SERVICES 1.0000 25.00000 25.00 0
JI* F
Legend:,;,; Invoice Subtotal: 420.74
E= Netere&;1 Taxable, Entered by Hand Indiana Sales Tax On: 0.00 0.00
Invoice Total: 420.74
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1- 800 424 -9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer PO Customer Signature:
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))
06/10/08 I BB 006640 I I $420.74
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 NO. WARRANT NO.
Hamilton County CO -OP ALLOWED 20
IN SUM OF
P.O. Box 1106 16222 Allisonville Road
Noblesville, IN 46060
$420.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1115 BB 006640 42- 313.00 $420.74 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
Thursday, June 19, 2008
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Noblesville —Office Horton Feed Grain Sheridan Plant Food LP
ioimtv 773 -0870 758 -4463 758 -5858
4 m9ton
Grain Terminal Noblesville- Petroleum Gray Storage
COOPERATIVE ASSOCIATION, INC. 773 -2599 Plant Food Station 776 -4155
Merchandising 776 -4143
16222 Allisonville Road P. O. Box 1106 Noblesville, Indiana 46061 773 -2685
S
L CARPIEL STREET DEPT <CHARGE SAL
LD9
T 34100 W 131ST STREET
0 WESTFIELD IN 46074
ACCOUNT N0. I PURCHASE ORDERNO. SALES TAX LICENSE NUMBER SALESMAN TERMS: INVOICE NO. DATE PAGE
PAYMENT DUE ON THE LAST DAY OF THE
c ETURN FOLLOWING TT UST MONTH CCOMPANIED BY
3117 lU THIS INVOICE. =100635 061161 08
RI AMOUNT
CROSSBOW (2.5GL) 32286 2.5000 GAL 67.5000 168.75
.00 166.75
All accounts subject to court EIVED I GOOD 0 R AMOUNT PAID CASH DISCOUNT
costs and attorney fees if legal i
action is necessary to collect CUSTOMER
said amount. SIGNATURE
Emergency Contact: LATE CHARGE PER MONTH PER ANNUM
Chemtrec 1 -800- 424 -9300 CUSTOMER COPY
I
�y
MO. DAY qy l 6 9 0 7 amilton V I
A
c N
EUnty 1
P )4 A N
R M v �YJ%C 1�
FARM BUREAU COOPERATIVE N E
ASSOCIATION, INC. A
o
P.O. Box 1106
16222 Allisonville Road
Noblesville, Indiana 46060_,- C CT:
CHEMTREC 1- 800-424-9300
SOLD BY CASH CHARGE ON ACCT MDSE. RET. TERMS
OTY DESCRIPTION MIN. comm. UNIT PRICE AMOUNT
3
4
t
�a
,.f
SUB TOTAL
SALES TAX ON
Received By rorAL
Additional finance charges may accrue at the rate of 1 per month (21 ^/o APRO)
if payment in lull is not received by the 30th. Minimum $.50.
FERTILIZER /PETROLELIM GRAIN MERCHANDISING SHERIDAN HORTON ELEVATOR
776 -4143 773 -2685 758 -4181 758 -4463
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))
06/04/08 69077 $21.88
06/16/08 400635 $168.75
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 NO. WARR NO.
ALLOWED 20
Hamilton Co. Co -op
IN SUM OF
P. O. Box 1106
Noblesville, IN 46061
$190.63
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
2201 69077 42- 389.00 $21.88 1 hereby certify that the attached invoice(s), or
2201 400635 42- 389.00 $168.75
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
Thursday, June 19, 2008
i
Street Co nAissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund