167678 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 00350781 Page 1 of 1
ONE CIVIC SQUARE PICKETT'S PLACE
CARMEL, INDIANA 46032 547 E 161ST ST CHECK AMOUNT: $30.00
WESTFIELD IN 46074 CHECK NUMBER: 167678
CHECK DATE: 117/2009
DEPARTMENT ACCOUNT PO NU INVOICE NU MBER AMOUNT DESCRIPTION
2201 4237000 879 30.00 REPAIR PARTS
PICKETT'S PLACE D IM W O D C IE
547E MST Invoice Number:
WESTFIELD, IN 46074 879
Voice: 317 896 -3271
Invoice Date:
Sold To: Fax: 317 896 -2036 Dec 22, 2008
Page
1
Came Street Department
5400 West '39st street
WESMELD, IN 46074
Customer ID Customer PO Shipping Method Payment Terms Due Date
VERBAL JEFF Cust. Pickup Net 30th of Next 1/30/09
h
Quantity Item Description Unit Price Amount
1.00 M10X1.25 BY 1/4 NPT ADAPTER 3" long 30.00 30.00
I
�j
r
Subtotal 30.00
Sales Tax
Total Invoice Amount 30.00
Check /Credit Memo No: Payment /Credit Applied
TOTAL 30.00
V OUCHER NO. WARRANT NO.
ALLOWED 20
Pickett's Place
IN SUM OF
547 E. 161st St.
Westfield, IN 46074
$30.00
ON ACCOUNT OF APP P I ION FOR
Carmel Street evart
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member:
2201 879 42- 370.00 $30.00 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
i 4nesda 8
St= C n nrrmics� ;nner
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/22/08 879 $30.00
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