160314 06/10/2008 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: 160314
CHECK DATE: 6110/2008
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUN D ESCRIPTION
1125 4355300 111782210077 40.00 ORGANIZATION MEMBER
I
Carmel e Clay
Parks &Recreation CHECK REQUEST
Date: 6, O
Check payable to
Name: St�O
Address:
City, State, Zip _L
Mail check to payee Return check to requestor
Check Amount Date Required
Check needed for �-d e��,� �r r ��t ��,o r C�
r n
A n aL l of n 1` b W e f l ayl
Supporting documentation or receipt(s) MUST be attached.
To be paid from
Po N 1 ft
Budget account GL 43 S c 3 U o
Budget Line Description
Requested by (print): 1Co d 7'r Z e w -n-
Requested by (signature):
Approved by (signature of Division Manager):
on this date
Form revised 1 -21 -08
1
I
I
FOR COSTCO USE ONLY 22307
MKTG CAMPAIGN CODE AMT PAID l TENDER TYPE CLERK TILLx DATE l 7I
I M)MBDx❑❑❑❑ PCN F USD
COSTCO BUSINESS MEMBERSHIP APPLICATION
with optional application for The TrueEarnings' Business Card from Costco and American Express
GET PAID TO SHOP! t v K e.
EXECUTIVE MEMBERSHIP g (NESS NAME LICENSE NU R NU BER OF EMPLOYEES
is $100 a year, including a
free Household Card, tirrutone 2/JJ�r �C��� U
Executive Membership per BUSINESS MAILING ADDRE C R STATE ZIP CODE COUNTY {AREA CODE) BUSINESS PHONE +EXT
household and(or business /06
7
i E�L ADDRESS (optional) RESALE PERMIT NUMBER 91 STATE EXP. DATE
FV_j BUSINESS MEMBERSHIP
$50 a year including a free
wtgl[ESacE Household Card. A husiness lic rse Receive special offers and hot buys from eosteo.com.
(or 3 pieces of business 101 re tied RESALE PERMIT 11 LdI �/�STTAT�E EXP. DATE TOBACCO1 RESALE PERMIT NUMBER (SEE BELOW) TATE EXP. DATE
to apply lar membership. U) 0 o z
BUYING FOR RESALE: YES NO RESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHO�F INITIAL
DATE OF BIRTH LAST NAME LEGAL FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE IAREA CODE) ROME 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) (optional) circle one (optional) circle one (P.O. Box required if applicable)
FREE HOUSEHOLD CARD (optional) A Household Card is available to a primary or add -on Cardholders spouse, domestic partner, or immediate family member over the age of 18 and living at the same
address. Household Cardholders will he asked to present proof that they live 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 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
from o print on membership card( (optional) circle one (optional) circle one
40 BUSINESS ADD -ON CARD You may add Additional Cardholders to your membership for $40 each.
BUYING F RESALE: YES NO RESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHOTDER INITIAL
DATE OF BIRTH LAST ME LEG FIRST NAME MI DRIVER'S LICENSE NUMBER' STATE (AREA CODE) HOME PHONE
i 9 L
NICKNAME NAME PREFIX NAME SUFFIX HOME MAILING ADDRESS CITY STATE ZIP COUNTRY
Mr Mrs Ms Miss Or Other Jr Sr 11 Other
(nam to print on membership card) (optional) circle one (optional) circle one (P.O. Box required if applicable)
E -M I AIL ADDRESS (optionalP Receive special offers and hot buys from costco.com.
'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,
r BUYING FOR RESALE: YES NO RESALE/TAX EXEMPT AUTHORIZED: YES NO PRIMARY CARDHOLDER )NITIAL
DATE OF BIRTH LAS ME LEGAL FIRST NAME M! DRIVER'S LICENSE NUMBER' STATE NICKNAME NAME PREFIX NAME SUFFIX
�W L L Mr Mrs Ms Miss Or Other Jr Sr 11 Other
2 Iname to print an membership card) loptionat circle one (optional) circle one
X as THOD O F PAYM ENT FOR COSTCO MEMB Please include sales tax in NY, Hl, AZ, NM, UT, NJ. WI, plus all other applicable states. Fees are subject to change.
h /Check Deblt/ATM C rd American Express Save time and postage —check here to renew your annual membership automatically on your American Express Card DMEMBEA'S AT�
Date:
1
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 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
6/2/08 1.11782E +11 Additional memberships for 40.00
Charles Redmon Tami Powell
Total 40.00
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.
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
1.125 111782210077 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
9 -Jun 2008
Sig nature
40.00 Busir S ices Manager
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund