164423 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 00350958 Page 1 of 1
ONE CIVIC SQUARE SAMS CLUB DIRECT CHECK AMOUNT: $79.08
CARMEL, INDIANA 46032 P O BOX 530930
ATLANTA GA 30353 -0930 CHECK NUMBER: 164423
CHECK DATE: 9/30/2008
DEPA ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
%85.1 5023990 003138 A 79.08 OTHER EXPENSES
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I SAM "S CLUB DIRECT CREDIT
Account: 0402 70240115 9 Statement Date: 09120108 Page: 1 of 2
CITY OF CARMEL 3384
ATTN: ACCOUNTS PAYABLE
TWO CIVIC SQUARE
N CARMEL, IN 46032 -2584
0 0� Payments Received
08/25/08 (98.80) PAYMENT RECEIVED THANKNOU
08/25/08 0162489 (465.82) PAYMENT RECEIVED THAB➢ONK Y'CC4 YOU
Current Month's Invoices (Details Enclosed)
Date Invoice Amount Due Date Club Reference
09/04/08 003138 79.08 10/08/08 8168 090408
Past Due Invoices
Date Invoice AmountzDue -Date Club Reference
07/22/08 CF080722 50.00 09/08/08 ADMIN FEE
Current•invoices: $79.08 Send payments to:
Past- Due'Invoices: $50.00 P.048ox 530930
Atlanta GA30353 -0930
Unapplied�Payments
Credits`/ $0.00 0 o a Send inquiries (n6t- payments) to:
P.O. Box 8726✓
Dayton OH 45404 8726
Total $129.08 For Customer Service:
Call 1- 800 362 -6196
Credit Line $10000.00
Retain left hand portion for your records, send right hand portion noting items paid by a lZ
with your payment. If not sending stub, note account number, invoice number and amounts
being paid on your check.
Continue-
5966 0013 001 17 GV @fG PAGE 1 of 2
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Sf11m1��7 CLUB DIRECT CREDITR
Account: 0402 70240115 9 Statement Date: 09/20/08 Page: 2 of 2
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SAM'S CLUB DIRECT
P.O. BOX 530930
ATLANTA, GA 30353 -0930
CITY OF CARMEL Date of Sale: 09/04/08
Account 0402 70240115 9 Invoice: 003138
Club /Name: 8168 P.O.: 090408
Buyer: GARY CARTER
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N S.K.U. DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE
005045458 FOLGERS REG PCH GRID 4.00 EA 19.77 79.08
Subtotal: 79.08 Tax: 0.00 Balance Due: 79.08
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5966 0013 001 07 PAGE-2 of 2 COLR654A 3384
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total •O�j
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF$
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
6EP 2 9 2006
0
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway,.fund