172999 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 354115 Page 1 of 1
s`' ONE CIVIC SQUARE PURE BEVERAGE COMPANY CHECK AMOUNT: $552.00
r CARMEL, INDIANA 46032 3902 E 16TH ST, SUITE B
INDIANAPOLIS IN 46201 CHECK NUMBER: 172999
CHECK DATE: 5/27/2009
DEPARTMENT A CCOUNT PO NUM BER INVOICE NUMBER AM DESCRIPTION
1207 4239040 216875 552.00 FOOD BEVERAGES
PislRE AEV1 -:FiAGE t:(:1i'1►='ANY Palen I
Q35 STOUT FJ:I:L.D W.. DR. SUITE 101 Invoice Mos. W6875
:C►41D:iANf1t='t7i._IS; ':I:i *1 Dates 5/21/2009
AL W BFiClOi't;:ih'i.T.R Cat:li, K CLUB. 'siH7:K '1:{F4C1OK::ii'•I.T.R GOLF' CLUB
rO V,AM PAM LISTER'
1 2 1 2 0 BROOKSHIRE PAR1',LJAY 12120 SPCiOKG7I•'iIRE:. PARKWf Y
W# :i:f! 4(:,1:33 C',AF+;h'f[`L IN 460:31
4317)846-7431
74'31.
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Ci Ca't T'trena• Unit E x'tet'+t ►oei
Cl• ►vred S hi ppe d Un Deg <.ste Deg ;:t:°_r f''•rit:rp AA l( t.tn t
1: {i 10 CS 24/20oz i'1._AS f .LC llR7. ZL)1IA ARNOLD. 22.06 020, 00
UPC! 613008723460
5. ('1 24 0oz !'f...ASTIC ARIZONA 12.00 010.00
5 s (IS 04 /00oz i'LAS'i'3:W ARIZONA iiAGPe &.00. 110.0o
UPCz W3008723583
13 `:a Q S 24 /20oz- PLASTIC W:l:ZOi'•1 &l..EION 22.00 110" OI;.i
LJL:iC'- 61 3008 723
1 3.. #`:3 FUEL S.LJJtiI.i°IAROE. T'..30 2*. 00
f:lRii)EREDs ?C; StJ1r+- 7`t.l'1"f1L 52. PW
RATE 12 Etta: eive Icy T'iJ'; f�i... =fri�'u (Jiti
Cash Char €Ica
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
faoee�) Ze 7 Purchase Order No.
1�5 u 16 &1-1 /d Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total _5 �,2 CE)
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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
.3 go o a.<eJ biil(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge, is made were ordered and
received except
20
If Z
raa
,1 f nSI9 re
/C
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund