160809 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 360854 Page 1 of 1
ONE CIVIC SQUARE COSTCO CHECK AMOUNT: $40.00
CARMEL, INDIANA 46032 9010 MICHIGAN RD
INDPLS IN 46268 CHECK NUMBER: 160809
CHECK DATE: 612512008
DEPARTMENT ACCOUNT PO NUMBER INVOIC N UMBER AMOUNT D
1125 4355300 40.00 ORGANIZATION MEMBER
Carmel o Clay
Parks &Recreati CHECK REQUEST
Date: l8 U C:EI V E;D
JUN 1 8 2008
Check payable to BY'
Name: o 5 T L
Address:
City, State, Zip 1��;1 /�l/�I /lS,
Mail check to payee VRetum check to requestor
Check Amount Date Required
Check needed for 72)
PU r2.cy U Y s IF l C 7 e_ o
To be paid from
PO (if applicable)
Budget account GL /D f /,q S 4 3 5 5 2 ,p O
Budget Line Description 0rG�CLI�
Supporting documentation or receipt(s) MUST be attached.
Requested by (print): Z S
Requested by (signature): o
Approved by (signature of Division Manager):
on this date z° l d
Form revised 1 -21-08
1 fi I iI19 r AIISII� 9 .SllRi.!4'i�nP�lR�sa��,r.�.w
FOR COSTCO USE ONLY 22307
MKTG CAMPAIGN CODE AMT. PAID I'LNUER TYPE CLERK DATF:
Maivte I JC��_.J' —_I� IL] PCNL CJL. —I� JC- -J USD
COSTCO BUSINESS MEMBERSHIP APPLICATION
with optional application for The TrueEamingsJ Business Card from Costco and American Express
GET PAID TO SHOP! 3 I ,'11 g ET k' 777 77 7 7 7
J
EXECUTIVE MEMBERSHIP BUSINESS NAME LICENSE NUMB R NUMBER OF EMPLOYEES
is 5100 a year, including a
Tree Household Card. Limit one
Executive Membership per
household and /or business. BU
/SMM�.AAIFLING ADDRESS C STATE ZIP CODE COUNTY (AREA CODE) BUSINESS PHONE EXT
f-NruiLADORESpn a a I RESALE PERM) NUMBER k1 STATE EXP. DATE
11 BUSINESS MEMBERSHIP
1Arllo[E5461F $50 a year including a free
Household Card A business license Receive special offers and hot buys from costco.com
Ior 3 pieces of business IDI required SALE PERMIT NUMBER 12 STATE EXP, DATE TOBACCO RESALE PERMIT NUMBE fSEE BELOW) STATE EXP. DATE
v to apply for membership. �t
DL
BUYING FOR RESALE. YES NO HBSALE/TAX EXEMPT AUTHORIZED: YES NO PRIMA Y CARDHOLDER I AT
DATE OF BIRTH LAST NAME LEGAL FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE {AREA CODE( HOME PHONE
NICKNAME NAME PREFIX NAME SUFFIX HOME MAILING ADDRESS CITY STATE ZIP COUNTRY
Mr Mrs Ms Miss Or Other Jr Sr II Other
(name to print on membership card) (eptional)circle one optionaL circle one IP.O. Box required if applicable)
FREE HOUSEHOLD CARD Optional) A Household Card is available to a primary or add -on Cardholder's spouse, domestic partner, or immediate family member over the age of 18 and living at the same
address. Household Cardholders will be asked to present proof that they live at the same address as the primary or add -on Cardholder.
BUYING FOR RESALE YES NO HESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHOLDER INITIAL
DATE OF BIRTH LAST NAME LEGAL FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE NICKNAME NAME PREFIX NAME SUFFIX
Mr Mrs Ms Miss Or Other Jr Sr II Other
In to print on membership card) (optional) circle one loptional) circle one
$40 BUSINESS ADD -ON CARD You may add Additional Cardholders to your membership for $40 each.
B YING FOR RESALE: YES NO RESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHOLDER INITIAL
DATE OF BIRTH LA T WK_'L E LEGAL FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE IAREA CODE) HOME PHONE
l V 6-� X511 �y
NICKNAME NAME PREFIX NAME SUFFIX HOME MAILING ADDRESS CITY STATE ZIP COUNTRY
Mr Mrs Ms Miss Dr Other Jr Sr II Other
(name to print on membership card) (optional) circle one (optional) circle one (P.O. Box required if applicable)
E -MAIL ADDRESS (optional) Receive special offers and hot buys from costco.com.
FREE HOUSEHOLD CARD (oplional) A Household Card is available to a primary or add -on Cardholder's spouse, domestic partner, or immediate family member over the age of 18 and living at the same
address, Household Cardholders will be asked to present proof that they Five at the same address as the primary or add -on Cardholder.
BUYING FOR RESALE YES NO RESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHOLDER INITIAL
DATE OF BIRTH LAST ME
LEf�4L FFIIRRRS,,,T �NAMEMI DRIVER'S LICENSE NUMBER' STATE NICKNAME NAME PREFIX NAME SUFFIX z5w L I L /l i /C�(> J Mr Mrs Ms Miss Dr Other Jr Sr II Other
J (name to print on membership card) {optional) circle one (aptiorri circle one
v fl 0!) OF PAYM FOR COSTCO M EMBERSH IP: Please include sales tax in NY, HI, A2. NM, UT, NJ, WI, plus all other applicable states, Fees are subject to change
Cash /Check DebiVATM Card American Express Save time and postage check here to renew your annual membership automatically on your American Express Card
CARDMEMB SI //nn
Date:
v
I
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
J Purchase Order No.
Costco Terms
9010 Michigan Rd
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/18/08 Ck Request Add S.Carling C.Allen to Membership 40.00
Total 40.00
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
J
v
Voucher No. Warrant No.
Costco Allowed 20
9010 Michigan Rd
Indianapolis, IN 46268
In Sum of
40.00
ON ACCOUNT OF APPROPRIATION FOR
101 General
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Ck Request 4355300 40.00 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
19 -Jun 2008
'Pkil I Qim7YlJ?h
Signature
40.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund