174321 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 355466 Page 1 of 1
ONE CIVIC SQUARE KEITH FREER
CARMEL, INDIANA 46032 1413 N. FAIRVIEW STREET CHECK AMOUNT: $125.60
ALEXANDRIA IN 46001
CHECK NUMBER: 174321
CHECK DATE: 7/8/2009
DE ACCOUNT PO NUMBER INVOICE NU AM OUNT DESCRIPTIO
851 5023990 125.60 OTHER EXPENSES
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P.O. BOX 9476
MINNEAPOLIS, MN 55480 DATE /AMOUNT 4'.�•'•^'.x" """T'°7 {tit *Eia
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MEAN 8 201543125344 618M 0000 L g ®��a
ST# 0923 OP# V ♦DETACH HERE
MONEY ORDER uoubjsb96309 125.00 0 'll; Date
ORDER FEE 068113163351 0.60 N
5UBTOTRL 125.60 r t-
TOTAL 125.6
DEBIT TEND 125.60
CHANGE DUE 0.00 State .Z✓// Zip
EFT DEBIT PRY FROM PRIMARY Cell "`�7`�G� email ���yj� /��L�I!'?�• �!IJ
ACCOUNT 1453
125.60 TOTAL PURCHASE ip
REF 918100139367
NETWORK ID. 0076 RPPR CODE 096291
06/30/09 08:29:39 a order form per helmet (unless all are the same).
MONEY ORDER SERIAL NUMBERS we will contact you with price and order number.
20154312534 125 o
(This line for office use only)
ITEMS SOLD 2 specify order by circling your choice
leather front colors are BLACK, RED WHITE
TC# 0680 8893 6032 7848 2887
11��l11 1111111111111111111111111111 111111111����� 1111111/ tors on Helmet Shells Are $10.00 Extra ea.
Find simple tips and earth friendly
Products at walmart.com /sreen rately at @20.00 ea. Specify Size Small- Med -Lx or Xtra -Lg
06/30/09 08:30:00
ner and Hanger only! No Front or Trim!
$40.00 Size Black Red White other
2 The "IFD Helmet, Liner, Hanger, Brass Crown and Trim W/ 4 front
$50.00 $65.00 Size Black Red White other
4" Blank Leather Front Black Red White Yellow
3 The "Flew Englander" "fg3 Styie' All the above W /6" Brass Finial, Trim Hardware
$75.00 $95.00 Size Black Red White other
6 Blank Leather Front Black Red White
4 he "Vigiiane f850'sSrY[_E'" All t above W /8" Brass Hi- Eagle, Trim Hardware
$125.00 $150.00 Size 7' or /ICS ack Bl d White other cezf� Tin'/
8" Blank Leather Front Black Red White /7 /d 0 c/s
Send completed order form along W /Check (held until funds clear) or Money Order to:
The
"1R 1SH F /REJWAIV Is DERBY"
Make payable to: 1325 West C.R. 300 South
Tim Monaghan North Vernon, Indiana 47265
Email to:
tmonfire a,seidata.com
or call
Office 561- 267 -6002
Fax 812 -873 -1285
Mwdtjm06 /09
www.irish
6 MY /w e AW, x 1, F0, ye c w e, o, Lw b�
IP
Receipt /Invoice No. 6309
Name Keith Freer Date June 30, 2009
Address
City State Zip
Phone Cell 317- 460 -5792 email
Fire Department Affiliation, Club or Group Carmel Fire Department
4 The 'Vigilant" f850sSrYLE" With 8 ss HI- Eagle, Trim 8 Hardware Accessories
$125.00 $150.00 Helmet Shell B/a Red White other
8" Blank Leather Front Black Red White
Shell_$40.00
Liner—$25.00
Accessories_$ 65.00
Total
_$130.00
S /H_$20.00
Sul- Total_$150.00
t
Tax N /.4
Discount_$25.00
Total-$125.00
The
"IRISH FIREMAN'S DERBY"
Tim Monaghan
1325 West C.R. 300 South
North Vernon, Indiana 47265
email:
tmonfire@seidata.com
Cell 561- 267 -6002
Home 812- 873 -1285
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))
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.
C 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
JUL 6 Z009
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund