165945 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 00350958 Page 1 of 1
ONE CIVIC SQUARE SAMS CLUB DIRECT CHECK AMOUNT: $105.24
CARMEL, INDIANA 46032 P 0 Box 530930
ATLANTA GA 30353 -0930 CHECK NUMBER: 165945
CHECK DATE: 11112/2008
DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
851 5023990 006220 105.24 0402702401159
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Account: 0402 70240115 9 Statement Date: 10/20/08 Page: 1 of 2
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CITY OF CARMEL 3390
ATTN: ACCOUNTS PAYABLE
TWO CIVIC SQUARE
CARMEL, IN 46032 -2584
y Payments Received,
10/09%08 0164423 (79.08) PAYMENT RECEIVED THANK
10/09/08" 0164424 (50.00) PAYMENT RECEIVED THANK YOU
Direct Direct
Current Month's Invoices (Details Enclosed)
Date Invoice Amount Due Date Club Reference
v 10/06108 006220 105.24 11/08/08 8168 100608
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Currentlnvoices: $105.24 Send payments to:.,
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F P WBox 530930 n
Past'.Due Invoices: $0.00
Atlanta GA 30353 =0930
Unapplred Payments 4
Credits $0.00 Send inquiries (not'payments) to
es� P.O. Box 8726,
Direct Dayton OH 45,- 10�1
Total $105.24 For Customer Service:
Call 1 -800- 362 -6196
Credit Line $10000.00
Retain left hand portion for your records, send right hand portion noting Hems paid by a
with your payment. If not sending stub, note account number, invoice number and amounts
being paid on your check.
J Continue-
5966 0014 001 07 Dircrt PACE 1 of 2
i
SAW CLUB DIRECT COMMERCIAL
Account: 0402 70240115 9 Statement Date: 10/20/08 Page: 2 of 2
SAM'S CLUB DIRECT
P.O. BOX 530930
ATLANTA, GA 30353 -0930
CITY OF CARMEL Date of Sale: 10/06108
Account: 0402 70240115 9 Invoice: 006220
Club /Name: 8168 P.O.: 100608
Buyer: GARY CARTER
0
S.K.U. DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE
000665591 EX FINE CANE SUGAR 2.00 EA 5.13 10.26
004822824 COFFEE CREAMER 3.00 EA 5.30 15.90
005045458 FOLGERS REG PCH GRID 4.00 EA 19.77 79.08
Subtotal: 105.24 Tax: 0.00 Balance Due: 105.24._
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5966 0014 001 07 PAGE 2 of 2 COLR654A 3390
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Prescribed by Slate 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))
I
Total
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
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I 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
NO 00
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477
�20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund