179164 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD
CARMEL IN 46032 CHECK AMOUNT: $35.56
CHECK NUMBER: 179164
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4232000 125999 35.56 TIRES TUBES
S'
/v
LARK 622C S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 46032
4w (317) 844 -4839
t �J PENS IL
I, THE UNDERSIGNED, HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME, THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE
A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID. I FURTHER AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE, AND
IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING
AGENCY AND ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BY LAWS GOVERNING THESE TRANSACTIONS.
A finance charge of 13/4% Per Month will be charged on all Accounts 30 days Past Due. Annual Percentage Rate is 21 (Minimum 75) RECEIVED BY
SOLD TO: SHIP TO:
CARNEL NAYORIS OFFICE 5980/01 SANE INVOICE# 125999
ONE CIVIC Sr7UARE
CARNEL IN 46032
CUST P.O. MAKE -MODEL ID# MILEAGE TELEPHONE :ROUTE SLM SHIP VIA ORDER PACE REMARKS
571 -2400 0 1 N/A 127050 1,
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
Opened by Operator 7
10 /i5 ;q P5q?`4 NFT 10TH 1011 98 °38.48 7
STOCK NUMBER aUANTITI SIZE DESCRIPTION UNIT T F.E.T. EXTENSION
,ORDERS SHIPPED PREY. SNIP' PRICE z
714-7481 NARK
REPAIR TIRE IF POSSIBLE
CH EACH TIRE CHANGE '1. 1 15.00 .00 15.00
1845 20180010 COOPER TUBE 1 1 1 2. 55 0c^ .00 12.56
CL EADH CLEAN F X -A -FLAT 1 1 8.00 ,00 8.00
METHOD OF PAYMENT:
CHARGE: 35.56
CHANGE:
I
NOV 0 9 2009 l
Y
i
J
G... V 1,
7 'S if.le o TAXABLE MISC.
PARTS LABOR TAX /o AMOUNT TAX F.E.T. F AMOUNT INVOICE TOTAL
PLEASE P AY THIS AMOUNT
35.56 35.56
"You're Riding On Our Reputation
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (Rev. 7995)
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
C ACAO 1ST Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 3!5
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
/OUCHER NO. WARRANT NO.
ALLOWED 20
C 1GS1Z�� IN SUM OF
SL
ON ACCOUNT OF APPROPRIATION FOR
_1
)ZJ!5
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
IZ 35 5& 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
20
Slgnat� e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund