179620 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK AMOUNT: $45.00
CARMEL IN 46032
CHECK NUMBER: 179620
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESC
1110 4350101 126276 45.00 TRASH COLLECTION
LARK 6222 S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION Carmel, IN 46032
(317) 844 -4839
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1, TIE 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 BYLAWS 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) RECEI BY
SOLD TO: SHIP TO:
CARMEL POLICE DEPT. WOO/Of SAME INVOICE# 126276
THREW CIVIC SGIIARE
CARPEL IN 460132
CUST: P.O. MAKE- MODEL ID# MILEAGE TELEPHONE ROUTE SLM SHIP VIA ORDER PAGE REMARKS
(31 ?)571 -2,,55
e-ee ne n .a r uen
INVOICE DATE
INVOICE PREVIOUS SHIPPED TERMS 5 i w
NUMBER INVOICE NUMBER
Opened by Operator 8
STOEK UMBER 2 SIZ€ DESCRIPTION oRDERS SHPP EDPREV.Siiia, PRICE T FiE:T= EXTENSION
SCRAP SCRAP TIRE 18 X18 2.50 N 45. N
METHOD OF PAYMENT.
CHARGE- 455. 00
CHANGE: .0
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TharPARliSfor YOUILABE)ReSS TAX AMOUNT TAX F.E.T. AMOUNT INVOICE TOTAL
PLEASE PAY THIS AMUff
45 IA
"You're Riding On Our Reputation"
PrescACed 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
Clark tire Purchase Order No.
622 C South Rangeline Road Terms
Carmel, 1N 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/10/09 126276 payment for scrap tires 45.00
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
VgUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire
IN SUM OF
622 C South Rangeline Road
Carmel IN 46032
45.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 126276 501 01 45.000 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
November 19 20 09
A�J� U
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund