202859 10/19/2011 CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1
ONE CIVIC SQUARE MONARCH BEVERAGE CO INC
i CHECK AMOUNT: $227.20
CARMEL, INDIANA 46032 3737 WALDEMERE AVE
INDIANAPOLIS IN 46241 CHECK NUMBER: 202859
CHECK DATE: 10/19/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 227.20 FOOD BEVERAGES
Monarch Beverage Co., Inc.
9347 East Pendleton Pike Permit Nos:
Indianapolis, IN 46236 W49-08938
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(317) 612-1310 W49-87358
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i IN-P-1983
!I VC 1% W it DUNS NO. 00-054-0534
.'N I C.L 1A 4+ z LOAD I SALESMAN �ACCOUNT NO.J INVOICE DATE INVOICE NO.
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PAYMENT
CASH/CHECK
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X CUSTOMER'S
SIGNATURE x 61L�
DRIVER'S SIGNATURE 'YO611 SIGN #TUWE IS ACCEPTANCE OF ALL
17
OUR DRIVERS CANNOT P ICK UP PRODUCT UNLESS PICK UP IS PRINTED ABOVE ITEMS. PLEASE CHECK CAREFULLY. N INVOICE. M
NOTE: NOT RESPONSIBLE FOR SHORTAGES OR BREAKAGE AFTER MERCHANDISE CUSTOMER COPY
IS DELIVERED.
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
�It tF L.I2ag4w Purchase Order No.
kE Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
D �I
Total
l 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
61
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
.7-6 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
04 s� 2 �l
Si nature
So I�
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund