166773 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE AUTO SVC
1310 wSOUTH ST CHECK AMOUNT: $673.95
CARMEL, INDIANA 46032
LEBANON IN 46052 CHECK NUMBER: 166773
ow
CHECK DATE: 12/10/2008
DCPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 S11314 L108794 673.95 TIRES
Y iii.. w
LEaANON T I F2E ^U S VG
1310 W SOUTH STREET
LEBANON, IN 46052
(765)482 -5027
FEDERAL TAX ID# 351145753
X MVO C E 09/09/08 09/09/08
L 1 Q8794 09:19 AM 02:29 PM
7798 014473- 108794 TERR: 7798
PAGE: 01 NONSIG: 173531
BILL TO: CITY OF CARMEL (E05) �1
1 CIVIC SQUARE
CARMEL, IN 46032
PHONE 1....... (31 F� VEH YEAR /MAKE. 00 CHEVY TRUCK
PHONE 2....... 317)710 -2321" VEHICLE MODEL. K2500 3/4 TON 4WD PI
DATE REQUESTE VEHICLE COLOR. RED
TIME REQUESTED LICENSE /STATE. 60147 IN
RETURN PARTS.. NO ODOMETR IN /OUT 072791 72791
SALESMAN...... 002 002 VEHICLE ID 1GCGK24R5YR196036
PRIOR INVOICE. 108688
ACCOUNT COB TC CUST# TYPE /STATE
779800168 4 01 00168 4 IN
SLSM TECH PRODUCT CODE BC OTY DESCRIPTION PARTS LBR /EXCISE LINE TOTAL
006 752 -353 -812 -0 G 4 LT245/75R16E WKHSF XGRCBSL TL 143.15 .00 572.60
GS NUMBER. G0730929 QTY. 4 NO. PJ11PFLR1808
006 017 020 044 -263 R 4 WHEEL BALANCE COMPUTER SPIN .00 8.00 32.00
006 017 020 041 -263 R 4 NEW VALVE STEM 2.00 .00 8.00
002 017 020 040 -101 R 4 AUTO < TRK INSTALL -NOT PURCH IN STORE .00 5.00 20.00
002 017 020 093 -002 R 4 TIRE DISPOSAL .00 3.00 12.00
002 017 020 046 -200 R 1 R/F WHEEL STUD AND LUGG 8.88 .00 8.88
006 017 020 046 -100 R 1 R +R WHEEL STUD LABOR .00 15.00 15.00
REMEMBER TO SERVICE YOUR TRANSMISSION EVERY 15000 TO 30000 MILES! WE THANK YOU FOR YOUR BUSINESS WITH US.
U"
I UNDERSTAND THAT ALL CUSTOM WHEEL LUG NUTS MUST BE RE- TORQUED AFTER 25 MILES AND CHECKED PERIODICALLY.
(signature)
PARTS TOTAL........ 589.48
LABOR TOTAL........ 79.00
CHARGED AMOUNT 673.95 MISC SHOP SUPPLIES. 4.47
STATE TIRE FEE 1.00 SUB TOTAL.......... 672.95
X---- TAXABLE AMOUNT 00 SALES TAX.......... .00
CUSTOMER AUTHORIZATION FOR TOTAL 3 N O I C E T O TA L X 6 7 3 9 5
TREAD L /F..... 11/32 TREAD R /F..... 11/32 TREAD R /R..... 11/32 TREAD L /R..... 11/32
BUYING PLAN... A OF PAYMENTS, 1 PAY START DATE 10/10/08 DISCOUNT...... *NET*
SEE F2EN/ EIRSE SS ®E FOFZ 31MFOFZ V^MT SAFETY
WAa" $NO AMU W^MMANTI( 2NF®►F2MAT�ON
VOUCHER 086751 WARRANT ALLOWED
132450 IN SUM OF
LEBANON TIRE AUTO SVC
1310 W SOUTH ST
LEBANON, IN 46052
Carmel Wastewater Utility
SON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
L108794 01- 7500 -02 $6 5
P
Voucher Total $673.95
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
r•
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
182450
LEBANON TIRE AUTO SVC Purchase Order No.
1310 W SOUTH ST Terms
LEBANON, IN 46052 Due Date 11/25/2008
Invoice Invoice Description
Date Number (or note invoice(s) or bill(s)) Amount
11/25/2001 L108794 $673.95
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer