168534 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $47.08
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278
CHECK NUMBER: 168534
CHECK DATE: 2/4/2009
DEPARTMENT AC COUNT PO NUMBER INV OICE NUMBER AMOUNT D ESCRIPTION
2201 4231100 00519062 47.08 BOTTLED GAS
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ORIGINAL INVOICE
I.NDIAN1X, INDIANA OXYGEN COMPANY _C USTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 00519062 ORDER: 01119526 -00
INDIANAPOLIS, IN 46278 -0588 INV DATE: 01/20/09 ORDDATE: 01/20/09
317 290-0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 j INT: BMK
PIO: WILL DAVIS
TERMS: NET 30
SHIP VIA: Will Call
RELEASE#:
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B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
L 3400 W 131ST ST P 3400 W 131ST ST
WESTFIELD IN 46074 WESTFTELD IN 46074
T T
0 0
INVOICE AMOUNT: 47.08
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
B; -r DESCRIPTION. UOM UNIT
JTEM AMOUNT
r PRICE
Location: D
OX 220 1 0 1 1 OXYGEN, COMPRESSED, 2.2 CYL 40 -182 40.18
UN1072
220CF 18.2645/100CF
FSCFUEL SRCHGWO 1 0� TEMP FUEL SURCHARGE W/C EA 3.95 3.95
HMCHAZ MAT CHC', 1 0: HAZARDOUS MATERIAL CHARGE i EACH 2.95 2.95
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Subtotal 47.08
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 1!
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emaiil inv�oice@�india
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Taxable amount:] 0.00 j
CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT 47.08 a i
THIS INVOICE
3400 W 131ST ST fNVOICE: 00519062
INCLUDING TAX
WESTFIELD IN 46074 INVOICEDATE: 01/20/09
ORDER: 01119526 -00 P /O: WILL DAVIS
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
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))
01/20/09 00519062 $47.08
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
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$47.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 00519062 42- 311.00 $47.08 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
a Thu rs ay, n ary 29, 2009
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y
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Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund