166728 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
PO BOX 78588 CHECK AMOUNT: $72.30
,a CARMEL, INDIANA 46032
INDIANAPOLIS IN 46278 CHECK NUMBER: 166728
CHECK DATE: 12/10/2008
DEPARTMENT A CCOUNT PO NUMBER INVOI NU MBER A DES
2 2201 4231100 08013813 72.30 BOTTLED GAS
i
CYLINDER RENTAL INVOICE
IN IJIANA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 08013813
INDIANAPOLIS, IN 46278 -0588 INV DATE: 11/30/08
317 290 -0003 SALESPERSON: 0 0 0 1 TERR: 007
BRANCH: 004
P /O:
TERMS: NET 3 0
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
3400 W 131ST ST P 3400 W 131ST ST
WESTFIELD IN 46074 WESTFIELD IN 46074
T T
O O
INVOICE AMOUNT: 72.30
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
INV ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED ENDING LEASED gAUDAYS CYLINDER EXTENDED
yI BALANCE BALANCE CYLINDERS RATE AMOUNT
R 050 1 0 0 1 0 30 .290 8.70
R 11X 1 0 0 1 1 0 .290 .00
R 147 3 0 0 3 0 90 .320 28.80
R 220 3 0 0 3 0 90 .290 26.10
R 330 1 0 0 1 0 30 .290 8.70
'PAX: .00
CARMEL STREET DEPT CUSTOMER: 07851 TOTAL 72.30
3400 W 131ST ST INVOICE: 08013813
WESTFIELD IN 46074 INVOICEDATE: 11/30/08
TOTAL CYL VALUE: 1800.00 P /O:
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
VOUCHER NO. WARRANT N
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
,Indianapolis, IN 46278 -0588
$72.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Member
2201 08013813 42- 311.00 $72.30 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, December 04, 200E
6
Streettdmmissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
11/30108 08013813 $72.30
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