166886 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 362262 Page 1 of 1
ONE CIVIC SQUARE SELKING INTERNATIONAL
CHECK AMOUNT: $2,523.23
CARMEL, INDIANA 46032 3801 EAST MCGALLIARD
MUNCIE IN 47303 CHECK NUMBER: 166886
CHECK DATE: 12/1012008
DEPARTMENT ACCOUNT PO NUMBER I NVOIC E N UMBE R AMOUNT DESCRIPTION
1120 4351000 W519737 3,118.23 AUTO REPAIR MAINTEN
1120 4351000 W520177 3,118.23 AUTO REPAIR MAINTEN
1120 4351000. W52.0178 2,523.23 AUTO REPAIR MAINTEN
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SELKING INTERNATIONAL IDEALEASE
5850 W. Hwy 224 2807 Goshen Rd. 3801 East McGalliard 6503 N. Old HWY 27 4i A
Decatur, IN 46733 Fort Wayne, IN 46808 Muncie, IN 47303 Fremont, IN 46737
tHTERN ATEONAL (260)724 -2166 (260)482 -3000 (765)282 -2276 (260)833 -0650
Fax: (260) 724 -2209 Fax: (260) 484 -4034 Fax: (765) 284 -7544 Fax: (260) 833 -0673
SALES PARTS SERVICE LEASING RENTAL rrrv�rr rr,�vr�cr
www.selkinginternational.com
CUSTOMER COPY"
CARMEL FIRE DEPARTMENT OUST# 8812 RO# W519737 PG 1
2 CIVIC SERVICE TRACK START 9/02/08 15:39
WARR VEN NAV BILLED 9/22/08 13:20
CAR14EL IN 46032 PO#
WRITER SS
PHONE: WORK 317 571 -2600 APPROVAL /MIC
DENISE- 3• -17 571 -2622 DEDUCTIBLE 3,118.23
OWNER 8812 UNIT# A45 2003 INTERNATIONA 4300 SBA L CURR MI 78,501.0
TRANS: 6510401909
VIN: 3HTMNAALX3N585816 ENGINE: 470HM2U1380576
WARRANTY EFF: 2/24/03 EXT: N UNIT: EXP:
LIST UNIT PRC EXT PRICE
{W) 1. COMPLAINT: CYLINDER OIL RING MAY BE BAD. OIL BREATHER TUBE /VENT TUBE
HAS WHITE FOAMY SLUDGE COMING OUT OF IT. ALSO NEEDS CLEANED
BEFORE THE TRUCK IS RETURNED. ENGINE MAY NEED
OVERHAULED???
CAUSE: SCORED #1 CYLINDER.
CORRECTION: RAN ENGINE,DRAINED COOLING SYSTEM.DRAINED OIL AND REMOVED
OIL PAN.FOUND #1 CYLINDER SCORED.CONTACTED GREG METTLER AND
WAS ADVISED TO INSTALL WORKS KIT UNDER POLICY.DIASSEMBLED
ENGINE,INSTALLED NEW ROD AND MAIN BEARINGS,6 LINER KITS.
INSTALLED NEW OIL PAN.CLEANED CYLINDER HEAD AND REINSTALLED.REFILLED WITH
ENGINE OIL AND COOLANT.STEAM CLEANED ENGINE.TEST DROVE UNIT.
LABOR:
PARTS: 6.00 ZDEM720 BRAKE CLEA
2 uv 18247 i RINv
2.00 1824735CI RING, OIL
4.00 1821098C2 RING, 0
1.00 1830362CI SEAL, OIL
1.00 ZDEM720 BRAKE CLEA
10.00 840381 DISC, 2" R
5.00 1812348C1 SLEEVE, FU
1.00 1836195C98 KIT,IN FRA
1.00 1836082092 PAN
1.00 1833356095 KIT,OIL PU
TERMS OF SALE
(I) All sales cash unless prior arrangements have been made, if charge, all amounts are due and 1 hereby authorize the above repair work to be done along with necessary materials. You and your
payable net ten orox. (due by the 101h of the month following billing.) No discounts permitted. employees may operate vehicle for purpose of testing, inspection or delivery at my risk. An express
l XI past due amounts are subject to a service charge of 1.5% per month (18% per annum) on all mechanic's Tien is acknowledged on vehicle to secure the amount of repairs thereto. You are net
balances thirty (30) or more days past due. responsible for loss of or damage to the motor vehicle or its contents due to collision not due to your
negligence; or due to fire, theft, or other casualty regardless of whether or not such fire, theft, or other
PAny warranties on the item(s) sold above are available only from the manufacturer or rebuilder of said casualty is due to your negligence; and you and your agents are hereby released from any and aft
item(s). Selking agrees to pass to customer any available warranties. Setking makes no warranties claims for such foss and damage.
of merchantability or fitness for a particular purpose of any parts sold and authorized no person to
assume for it any liability in connection with the sales of parts.
(a)By providing sales tax exemption number customer certifies he is exempt from any sales or
occupation tax and agrees to be responsible for any tax assessment made by the state of Indiana or
ether taxing authuity and agrees to reimburse r e for any amount now due becoming due X
including penalties if assessed. In addition, buyer r agrees to pay cast of past due collection, including
reasonable attorneys fees. BY
NOT RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLES OR ARTICLES LEFT IN VEHICLES IN CASE OF FIRE, THEFT, OR ANY OTHER CAUSE BEYOND OUR CON
SELKING INTERNATIONAL IDEALEASE
1850 W. Hwy 224 2807 Goshen Rd. 3801 f=ast McGalliard 6503 N. Old HWY 27 C
Decatur, IN 46733 Fort Wayne, IN 46808 Muncie, IN 47303 Fremont, IN 46737
€4TERNATIOMAL (260) 724 -2166 (260)482 -3000 (765)282 -2276 (260)833 -0650
Fax: (260) 724-2209 Fax: (260) 484-4034 Fax: (765) 284-7544 Fax: (260) 833-0673 C.
SALES PARTS SERVICE LEASING RENTAL
www.selkinginternational -com
CUSTOMER COPY
CARMEL FIRE DEPARTMENT CUST# 8812 RO# W519737 PG 2
1.00 1817849C3 GASKET
1.00 765 -1393 WHITE GREASE
1.00 765 -1217 ADHESIVE
1.00 RED HIGH TACK
1.00 18123480/ SLEEVE, FU
2._00 1.825E88C1 ELEMENT,DT
8.00 ZSH940420602IG ANTIFREEZE
8.00 ZSHSO70719B OIL, SHELL
2.00 250670401 CLAMP, HEA
1.00 1822135CI 0 -RING, BR
1.00 1862X6 3/8 TUBE U
TOTAL LABOR .00
TOTAL PARTS .00
REPAIR ORDER SUBTOTAL .00
DEDUCTIBLE 3,118.23
REPAIR ORDER TOTAL 3,118.23
CHARGED TO YOUR ACCOUNT 3,118.23
TERMS OF SALE
All sales cash unless prior arrangements have been made, if charge, all amounts are due and 1 hereby authorize the above repair work to be done along with necessary materials. You and your
payable net ten prox. (due by the 10th of the month following billing.) No discounts permitted. employees may operate vehicle for purpose of testing, inspection or delivery at my risk.' An express
past due amounts are subject to a service charge of 1.5% per month (18% per annum) on all mechanic's lien is acknowledged on vehicle to secure the amount of repairs thereto. You are not
balances thirty (30) or more days past due. responsible for loss of or damage to the motor vehicle or its contents due to collision not due to your
negligence; or due to fire, theft, or other casualty regardless of whether or not such fire, theft, or other
(3tAny warranties on the items) sold above are available only from the manufacturer or rebuilder of said casually is due to your negligence; and you and your agents are hereby released from any and all
itern(s). Selking agrees to pass to customer any available warranties. Selking makes no warranties claims for such loss and damage.
of merchantability or fitness for a particular purpose of any parts sold and authorized no person to
assume for it any liability in connection with the sales of parts.
(a)By providing sales lax exemption number customer certifies he is exempt from any sales or
occupation tax and agrees to be responsible for any tax assessment made by the state of Indiana or
other taxing authority and agrees to reimburse Selking for any amount now due or becoming due X
including penalties if assessed. In addition, buyer agrees to pay cost of past due collection, including
reasonable attorneys fees. BY
NOT RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLES OR ARTICLES LEFT IN VEHICLES IN CASE OF FIRE, THEFT, OR ANY OTHER CAUSE BEYOND OUR CONTROL.
Pe c, 1. 2008 3;31PM No. 3802 P. 2/5
SELKING INTERNATIONAL ID -RAS CA
1850 W. Hwy 224 2607 Goshen Rd. 3801 East MuGalliard 6503 N. Old HWY 27 IGBALLOR
Decatur, IN 46733 Fork Wayne, IN 46808 Muncie, IN 47303 Fremont, IN 48737 AM
1110RIiATIONAL (260) 724 -2166 (260) 482 -3000 (765) 2$2 -2276 (260) 833 -0650
Fax: (260) 724-2209 Fax: (260) 484 -4034 Fax, (765) 284-7644 Fax; (260) 8330873
SALES PARTS SERVICE LEASING A SAL
www.salkingintematonal.com
CUSTOMER COPY
CARMEL FIRE DEPARTMENT OUST# 8812 Rib# W520177 PG 1
2 CIVIC SERVICE TRACK START 12/01/08 15 :03
BILLED 12/01/08 15:13
CARMEL IN 46032 PO#
WRITER MTC
PHONE: WORK 317 000-0000 APPROVAL /MIC
DENISE 317 571 -2622
OWNER 8812 UNIT# A45 2003 INTERNATIONA 4300 SBA L CURR MI 78,501.0
TRANS: 6510401909
VIN: 3HTMNAALX3N585816 ENGINE: 470HM2U1380576 I
WARRANTY EFF: 2/24/03 EXT: N UNIT: EXP:
I
LIST UNIT PRC EXT PRICE
(W) 1. COMPLAINT: CREDIT INVOICE #519737 AND REBILL CORRECTLY.
LABOR:
PARTS: 6.00— ZDEM720 BRAKE CLEA
2.00— 182473601 RING
2,00 1824735C1 RING, OIL
4.00- 182109$C2 RING, 0
1.00- 1830362C1 SEAL, OIL
1.00— ZDEM720 BRAKE CLEA
10.00- 840381 DISC, 2" R
5.00- 181234801 SLEEVE, FU
1.00— 1836195C98 KIT,IN FRA
1,00— 1836082092 PAN
1.00— 1833356095 KIT,OIL PU
1.00— 1$17$4903 GASKET
1.00- 765 -1393 WHITE GREASE
1.00- 765 -1217 ADHESIVE
1.00- RED HIGH TACK
1.00- 181234801 SLEEVE, FU
2.00- 1825688CI ELE MEN T,DT
6.00— ZSH940420602IG ANTIFREEZE
8.00- ZSHSO70719B OIL, SHELL
2.00- 250670401 CLAMP, HEA
1.00- 1822135C1 O -RING, BR
1.00- 1862X6 3/8 TUBE U
TERMS OF SALE
Alt salea cash unless prior arrangements have geen made, If theeee all amounts are duo and 1 Mangy avoorize the above k e repair w to I* done along with neoeaaary materials. You and your
payable net 1M prox. (due by the 1 of the month following billing.) No discounts permitted, employees may operate vehicle for purpose of tesdny, inspedon or delivery at my risk. An express
(a)AII past due amounts era Bub)ed to a service Charge d 1.5% per month (18% per annum) on all mecnanlc'e son is acknowledged on vehicle to secure the amourn of repairs thereto. You are not
belathces thirty (3D) w more days past due. restrvnSible for 1= of or damage to the motor vehicle or its contents due to collision not due to your
negligence; or due to fire, theft ss or other muahy regardle of wh" or got such fife, M or other
warrsncea on the hem(s) sold abwvo ate available Only from the manufacturer or mbullder of said casJ1H Is due to your negllger>ce; and you and your agents are hereby released from any and all
hem(s), 56ki agrees pass to cus tomer any available warranties, sdking makes no warranties clalms fU Such loss, and damaga-
of mffamrnal,I a f net o parbwIar purpose of anJy parffi add and authorized ft pennon to
"$uMe for it any Iiabitsy In wnneclion with the Sala of !tans.
(S)By prtxlding Sales Wx exemption number customer certfi% he is exempt from any sates or
occupstlan tax and e9MW to be re*P=ible for arrtyry tax assessment made by the State of Indiana or
other taxing authority and agrees to reimburse t3 iorig tot any amount now due or becoming due X
nGuding p neNes if assessed. In salimon, buyer agrees to pay WSt of past Cue collecton, Including
reaE4naDfs aROmeya fees. BY
NUT RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLES OR ARTICLES LEFT IN VEHICLES IN CASE OF FIRE=, THEFT, OR ANY OTHER CAUSE BEYOND OUR CONTROL.
i
Dec. 1. 2008 3;32PM No. 3802 P. 3/5
SELKI14G INTER14ATI ILEALEASE a a.
1850 W, Hwy 224 2807 Goshen Rd. 3801 East NlcGalliard 8503 N. Old HWY 27 R�EALEi�E
Decatur, )N 46733 Fart Wayne, IN 46808 Muncie, IN 47303 Fremont, IN 46737 AM
(260)724 -2166 (280)482 -3000 (765) 282 -2276 (280)833 -p850
Fax: (280) 724 -2209 Fax: (260) 484 -4034 Fax: (765) 284 -7544 Fax: (260) 833 0673 ift
SALES PARTS SERVICE LEASING RENTAL Zr_r-,Virr_ MITYGE
www.selkinglntemaflonal.com
CUSTOMER COPY
CARMEL FIRE DEPARTMENT OUST# 8812 RO# W520177 PC 2
MISC: MISC PARTS INV: DEDUCT
(C) 2. COMPLAINT: CUSTOMER PORTION.
LABOR:
MISC: MISC PARTS 3,118.23
TOTAL LABOR .00
TOTAL PARTS .00
TOTAL MISC EXPENSES 3,11$.23CR
REPAIR ORDER TOTAL 3,118.23CR
CREDIT TO YOUR ACCOUNT 3,118.23CR
i�
TERMS OF SALE
(1) All sales cash unless prior arrangements have been made. H charge all amounts ere due and (s) 1 h=ty aurrdrfae the above romir work to be done along with neoeasary materials. You and your
payable net ten prox. (due by the 10th of the month follow ng billing,) No d scount& permitted. employers may op"e vMide for pwrpaca rd teatln8, Inapedlur or delhvy at My W, An exV=
past due amounts are subject to a sent charge of 1.3% per month (18% por annum) on ab mechawa lien Is aukrtowledged on vehrde to secure the amount of repalra thereto. You are not
balances thirty (30) or nwre days past duo. rospansibte for tons of or damage to the motor vahido or its ooments due to calsslon not sue to yam
negligenca; or duo to fir*, theft. or other casualty regard am ar
less gf wriaer or Skit w, rep. or other
warranfift on No items) 90 above are aveflable only from the manufacturer or rebuilder of said La is due to your negligence; and you and your agents are hereby released trty and all
item(s)- %kinngg agrees to pass to =tornar any available wartantleg_ 8dking makes no warranties UaimE for svcm rpss and damage.
gf merchantabiliity or Ames for a partlatar purpose of any parts sold and authorized no person to for h any liability in tonn*et 0n with the sales d partB.
providdng sales tax exemption number aatomer ceMes he is exempt from any sales or
bccttpatlon tar and agrees to be Mponsibie for arr��yy tax saaessmem made by the stato of Indiana or
other taxing authority and agrees to relmburt4 SeliWo for any amount now due or becornlng due x
indum ngpenaides H assn w' in addition. buyer agrees to pay cost of past dug odledon, itid &ding
reasonable a8omtys fees. BY
NOT RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICL OR ARTICLES LEFT IN VEHICLES IN CASE OF FIRE, THEFT, OR ANY OTHER CAUSE BEYOND OUR CONTROL
Dec, 1. 2008 3:32PM No. 3802 P. 4/5
SELKING INTERNATIONAL I E DA
1850 W. Hwy 224 2807 Goshen Rd- 3801 East McGalliard 6503 N. Old HV Y 27 l *et+cASE
Decatur, IN 46733 Fort Wayne, IN 46808 Muncie, IN 47303 Fr emont, IN 46737
AINTERVATIOMAL (260)724 -2166 (260)482 -3000 (785)282 -2276 (260) 833 0650
Fax:
D)724-2209 Fax: (260) 484 -4034 Fax: (765) 284--7544 Fax: (250) 833 -0673
SALES PARTS SERVICE LEASING RENTAL
www.selkingintematonal.com
I
CUSTOMER COPY
CARMEL FIRE DEPARTMENT OUST# 8812 RO# W520178 PG 1
2 CIVIC SERVICE TRACK START 12/01/08 15 :13
BILLED 12/01/08 15:20
CARMEL IN 46032 PO#
WRITER MIC
PHONE: WORK 317 000 -0000 APPROVAL /MIC
DENISE 317 571 -2622
OWNER 8812 UNIT# A45 2003 INTERNATIONA 43001 SBA L CURR MI 78,501.0
TRANS: 6510401909
VIN: 3HTMNAALX3N585816 ENGINE: 470HM2U1380576
WARRANTY EFF: 2/24/03 EXT: N UNIT: EXP:
LIST UNIT PRC EXT PRICE
(W) 1. COMPLAINT: REBILL RO #519737 CORRECTLY.
LABOR:
PARTS: 6.00 ZDEM720 BRAKE CLEA
2.00 182473601 RING
2.00 182473501 RING, OIL
4.00 182109802 RING, 0
1.00 183036201 SEAL, OIL
1,00 ZDEM720 BRAKE CLEA
10.00 840381 DISC, 2" R
5.00 1812348C1 SLEEVE, FU
1,00 1836195C98 KIT,IN FRA
1.00 1836082092 PAN
1.00 1833356C95 KIT,OIL PU
1.00 181784903 GASKET
1.00 765 -1393 WHITE GREASE
1.00 765 1217 AD�IESIVE
1.00 RED HIGH TACK
1.00 1812348CI SLEEVE, FU
2,00 182568801 ELEMENT,DT
8.00 ZSH940420602IG ANTIFREEZE
8.00 ZSHSO70719B OIL, SHELL
2.00 250670401 CLAMP, HEA
1.00 1822135C1 0 -RING, BR
1,00 1862X6 3/8 TUBE U
I
TERMS OF SALE I
(t) All sales cash unless prior arrangements havo been made, if charge, all amounts are due and (5) 1 hereby authorize the atwvt repsir work to be done along with ng"mury materials- You antl your
payable net ten orox. (due by the lath of the month following billing,) No discounts permbid. emplgyeea may operate vaNde fur p ose urp of testing. insper.4m or delivery at my risk, M mross
WAII past due amounts are subject to a aervio9 Chafga 9f i,b% per month (1890 per annum) m ail machantcs liar is acknowledged on vehicle to secure tiro amount of repars thereto You are not
balanaa 4 mounts
Or more days peat due. responsible for loss of or damage k0 lilt motor vehicle or I[a cantenis duo to Oo llswn nq tlue is you r
negligence; or due to fire, than, or other Casualty repro ass of whether or not such fire, matt, or other
(s)Any warranties on the items) sold above ate available only from the manufacturer or rebulider of sell casualty is due to your negligence: and you and your agents are hereby released from any and all
,fzs), Sulking agrees !o pass to custanar any available warranties. Sulking makes no warranties alms for such loss and damage.
of merdhernabliny orfitnas for a par W lar purpose of any parlor sold and authorized no person to
assume for 4 any liability In connecdon with the salts of pans.
(4)B pravidng Sala tax exemption number customer cwffles he is exampl from any sales or
occupation tax and agrees 10 be moonsiple for a�Y tax sseen ment made by the state of Indiana or
Other taxing autnorny and agmea to ralmbunse Sulking for any amount now sue or becoming due X
Indudi penaMss iF w4essed. In addition, buyer agrees to pay oust of past due collection, irlduding
reas0nabla at}ameri fees. By
NOT RESFON518LE FOR LOSS OR DAMAGE TO VEHICLES OR ARTICLES LEFT IN VEHICLES IN CASE OF FIRE, THEFT, OR ANY OTHER CAUSE BEYOND OUR CONTROL-
Dec, 1. 2008 3; 32PM Nc. 3802 P. 5/5
SELLING INTERNATIO IDEALEASE CAT
1850 W. Hwy 224 2807 Goshen Rd. 3801 East McGalliard 6503 N. Old HWY 27 x
Decatur, IN 46733 Fork Wayne, IN 46808 Munch®, IN 47303 Fremont, IN 46737
4411u ZONAL (260) 724 -2166 (260) 482 -3000 (7U)2a2-2276 (260) 833 -0650
Fax: (260) 724-2209 Fax: (260) 484-4034 Fax: (765) 284-7544 Fax: (280) 833-0673
SALES PARTS SERVICE LEASING RMMAL rGI;VICE: 10VOICG l
www.selkln9l nternatonal, coon
CUSTOMER COPY
CARMEL FIRE DEPARTMENT CUST# 8812 RO# W5 20178 PG 2
MISC; MISC PARTS
(C) 2. COMPLAINT; CUSTOMER PORTION OF REPAIR. ORIGINAL RO #519737 BILLED
INCORRECTLY. CREDITED ON RO #520177 AND REBILLED CORRECTLY
ON THIS RO #520178.
LABOR:
MISC: MISC PARTS INV: DEDUCT 2,523.23
TOTAL, LABOR .00
TOTAL PARTS .00
TOTAL MISC EXPENSES 2,523.23
REPAIR ORDER TOTAL 2,523,23
CHARGED TO YOUR ACCOUNT 2,523.23
I
r
TERM$ OF $ALE
(1) All talc cash ur4m prior arm Nementa have been made, If charge a11 amounts ate duo and (5) 1 here0y outhvft the shove repair work to be done along with flocmwy materials. You and your
payable net ten prox. (due by the 10th of the MWth following Dilling.) No discounts pem+iaed- employees may operate vahide for purpme of testing. Inspection or delivery at my dak. An expreea
past due am rvi
amounts are sub eot to a sece Crta� of 1.5% a month 18% r annum) on all meea+anrc's lien Is acknowledged on vahide to secure the amount of repairs thereto. You are net
W OWS thlny (30) or more days past due. res"utblo lot I= of or damage to the motor vehide or its QoAW i tlue to oolfi; ion not duo to your
negligence; or due to fir*, theft, a other uKuatly regardita of whether or not such 8re, then, or other
warranties on rho item(&) cold above are available only from the manufacturer or rebvildsr of said tas�atry s due to your nep112artca; and yvu and your 09M he
R& are reby released om fr any and all
Item(e}. 9elklnit egress to pass to customer any avaitabis warranties. SelYing malcea no warranties daima fvt;uch Itws and eamaga
ct merrkantahilay tx tlmoBe for a particular purpose of any parts sdd and ak4norixed eo omen to
assuma for 4 any liability in conneebon with me Bales of parts.
proiding sates tat *xsrhpbW nu{nber dntomer ce Ag$ he La exempt from &ny aales or
0=0*tion tax and agrees to be responsible for any tax aasotsntant made by the state of Nolan or
other wing authority and agrees to rnmtwrse 9e4kln2 for any amount now due or bocomiAogg due X
intluei Itfea K assessed. In addition. buyer agrtG to pay coat of past due calledon, Induding
roa&ataattomcys roes- BY
NOT RESPONSIBLE FOR LOSS OR DAMAGE TO VEHICLES OR ARTICLES LIrFr IN VEHICLES IN CASE OF FIRE, THEFT. OR ANY OTHER CAUSE BEYOND OUR CONTROL-
VOUCHER NO. z'VARRANT NO.
ALLOWED 20
Selking International
IN SUM OF
3801 East McGalliard
Muncie, IN 47303
$2,523.23
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# 1 Dept. INVOICE NO, ACCT #/TITLE AMOUNT Board Members
1120 W520178 43 510.00 $2,523.23 1 hereby certify that the attached invoice(s), or
1120 W520177 43 510.00 ($3,118.23) bill(s) is (are) true and correct and that the
1120 1 W519737 1 43 510.00 $3,118.23
materials or services itemized thereon for
which charge is made were ordered and
received except
�[�znna
a
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. )995)
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))
W520178 Repair A45 Cylinder Ring $2,523.23
W520177 CREDIT ($3,11823)
W519737 Repair A54 $3,118.23
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
2a
Clerk- Treasurer