176710 09/02/2009 0 a �,q;,f 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: $62.50
s'';a' CARMEL IN 46032 CHECK NUMBER: 176710
CHECK DATE: 9/2/2009
DEPARTMENT ACCO PO N UMBER INVOICE NUMBER AMOUNT D ESCRIPTION
1110 4350101 125474 62.50 TRASH COLLECTION
622C S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION" LARK Carmel, IN 46032
4w IRE (317) 844 -4839
�Jational PENS IL
1, 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 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) RECEIVED BY
SOLD TO: SHIP
TO
CARMEL POLICE DEPT. 6000101 SAME INVOICE# 125474
THREE CIVIC S1A0
CARMEEL IN 46032
i
CUST. P.O. MAKE -MODEL ID# MILEAGE r .TELEPHONE ROUTE SUM SHIP VIA ORDER PAGE REMARKS
571 -2500 0 5 N/A 125861 1
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
ed...
08/25!2009 1225474 NET 10TH 08/25/09 12:43 :28 8
STOCK NUMBER SIZE DESCRIPTION QUANTITY UNIT T F.E.T. EXTENSION
.ORDERS SHIPPED PREV. SHIP PRICE
SCRAP SCRAP TIRE 2S 25 2.50 .00 622.50
METHOD OF PAYMENT:
CHARGE: 62.50
CHANGE: .00
Thank you for your business
PARTS LABOR TAX TAXABLE MOUNT TAX F.E.T. AMO NT t, w IN gI.CE TOTAL
62.50 62.50
"You're Riding On Our Reputation"
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
Clark Tire Purchase Order No.
622 C South Rangeline road Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/25/09 125474 payment for scrap tires 62.50
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.
ALLOWED 20
Clark tire
IN SUM OF
622 C South Rangeline Road
Carmel, IN 46032
62.50
ON ACCOUNT OF APPROPRIATION FOR
police general ufnd
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 125474 501 -01 62.50 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
August 28 20 09
1
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund