167602 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC CHECK AMOUNT: $89.95
CARMEL INDIANA 46032 622 C SOUTH RANGELINE RD
CARMEL IN 46032 CHECK NUMBER: 167602
CHECK DATE: 1/7/2009
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT D ESCRI PTI ON
651 5023990 122714 89.95 OTHER EXPENSES
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CARMEL All Claims and Returns MUST Be Accompanied By THIS INVOICE
C 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
(317) 4839 CHARGE .75). THE ANNUAL PERCENTAGE RATE IS 21
I LJJ FAX 844 844 6561 AGRICULTURAL EXEMPTION CERTIFICATE
844
I C 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
RESALE.
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CUSTOMER'S SIGNATURE
UNIROYAL
CARMEL WASTEWATER 6100/01 SOME INVOICE# 12
SOLD TO: 9609 HAZELDELL PKW. SHIP TO:
INDIANAPOLIS IN 46280
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"Ours is A Reputation You Can Ride On"
CUSTOMER COPY
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
060700
CLARK TIRE CARMEL Purchase Order No.
622C S. Rangeline Road Terms
Carmel, IN 46032 Due Date 12/29/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/2001 122714 $89.95
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 086969 WARRANT ALLOWED
060700 IN SUM OF
CLARK TIRE CARMEL
622C S. Rangeline Road
Carmel, IN 46032
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
122714 01- 7500 -02 $89.95
Voucher Total $89.95
Cost distribution ledger classification if
claim paid un v ehic le highw fund