168417 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
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ONE CIVIC SQUARE CLARK TIRE INC
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK AMOUNT: $84.00
CARMEL IN 46032 CHECK NUMBER: 168417
CHECK DATE: 2/4 /2009
DEPARTMENT ACCOUNT PO NU INVOICE NUMBER AMOUNT DESCRIPTION
1125 4350000 122861 31.50 EQUIPMENT REPAIRS M
1110 4350101 123048 52.50 TRASH COLLECTION
CARMEL All Claims and Returns MUST Be Accompanied By THIS INVOICE
LA R K 622 C. South Rangeline Road TERMS: NET 10TH FOLLOWING DATE OF PURCHASE. A SERVICE CHARGE
Carmel IN 46032 OF 1 PER MONTH WILL BE ADDED TO PAST DUE BALANCE (MINIMUM
e° (317) 844 -4839 CHARGE .75). THE ANNUAL PERCENTAGE RATE IS 21
FAX (317) 844 -6561 AGRICULTURAL EXEMPTION CERTIFICATE
STATE DEPARTMENT OF REVENUE —SALES TAX DIVISION
I HEREBY CERTIFY UNDER THE PENALTIES OF PERJURY THAT THE PERSONAL
PROPERTY PURCHASED BY THE USE OF THIS EXEMPTION CERTIFICATE WILL BE
DIRECTLY USED IN THE DIRECT PRODUCTION OF AGRICULTURAL PRODUCTS FOR
TOM RESALE.
i X
CUSTOMER'S SIGNATURE
UNIROYAL
CARMEL CLAY PflRKS RND REC 6350!01 I. SAME "f INVOICE# 122861
SOLD TO: 1411 E 116TH STREET SHIP TO:
CARMEL IN 46032 i w
CUST P O MAKE MODEL ID MILEAGEELEPHONE aourE suw SHIP VIA ORDER PAGE REMARKS
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INVOICE DATE NUMBER w PNVOI NUMBERD q TERMS t it t!#�E 7
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if /05 %g 3 i 122861 s. NET 10TH Y1 s 1 t
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euANnry °UNIT
STOCK NUMBER SIZE DESCRIPTION T F.E.T. EXTENSION
o nESS, SHIPPED _PREV SHIP, e PRICE
CH
TI RE CHANGE x. __,.00.�
911, REP EACH INSIDE TIRE REPAIR 1 Y 6.50 .00 2 VM,
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METHOD P l 1.,�
CHARGE: g 31.50
CHANGE: .00 �E 2ad9
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JAN 1
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1 a�
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Purchase, l
Descnptio
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C
a? Burlget� x
s Line Desc llG p r
a !'urch Date
PARTS LABOR r TAX D/o nMOUrJT TAX F E T AMOUNT-.-,, I�1 DICE TO ALUT
31.50 31.50
3.`
"Ours is A Reputation You Can Ride On"
CUSTOMER COPY
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
060700 Clark Tire Terms
622 S Rangeline Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/5/09 122861 Skidsteer tire repair 31.50
Total 31.50
1 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
060700 Clark Tire Allowed 20
6a� C S Rangeline Rd
Carmel, IN 46032
In Sum of
31.50
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #TITLE AMOUNT Board Members
Dept
1125 122861 4350000 31.50 1 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
27 -Jan 2009
Signature
31.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
r i
LARK 622C S. Rangeline Road
"YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 4603
4w (317) 844 -4839
ri iFE
at 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 TIE 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 HE'P YMENT 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 CHI RGE EQUAL TO HE CO T 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) RECEIVE BY
1
SOLD TO: CARMEL POLICE DEPT. 6000/01 SHIP TO: SAME INVOICE# 123048
THREE CIVIC SQUARE r
CARME!_ IN 46032
CUST. P.O. MAKE -MODEL ID# MILEAGE QI ELEPHO,,NE .ROUTE SLM SHIP VIA ORDER PAGE REMARKS
571 -2500 0 5 NIP 126718 1
INVOICE DATE` INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
01/23/2009 123048 NET 10TH 01/23/09 10:51:54 8
STOCK NUMBER SIZE DESCRIPTION QUANTITY,_ UNIT T F.E.T EXTENSION
ORDERS SHIPPED PREY SHIP'r.. PRICE
SCRAP SCRAP TIRE Z 21 2.50 .00 52.50
METHOD OF PAYMENT.
CHARGE: 52.50
CHANGE: .00
1
l
Thank you for your business
PARTS LABOR TAX% AMOUNT TAX F.E.T. AMOUNT INVOIGEITOTALi g
52.50 52.50
"You're Riding On Our Reputation"
Prescril. 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))
1/23/09 123048 a ent for scrap tires 52.50
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
C lark Tire
IN SUM OF
622.0 South Rangeline Road
Carmel IN 46032
52.50
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 123048 501 -01 52.50 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
JanuAr3�In 20 09
1
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund