167636 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $119.94
s s CARMEL, INDIANA 46032 PO aox 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 167636
CHECK DATE: 1!712009
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 00513221 119.94 BOTTLED GAS
t
ORIGINAL INVOICE
fN l_)IANA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 00513221. i ORDER: 011090 -00
INDIANAPOLIS, IN 46278 -0588 INV DATE: 12/18/08 ORD DATE: 12 /18/08
317 290 -0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 j INT: BMK
P /O: SHOP
TERMS: NET 30
SHIP VIA: Will Call
RELEASE N:
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
3400 w 131ST ST P 3400 w 131ST ST
WESTFIELD IN 46074 WESTFIELD IN 46074
T T
0 O
INVOICE AMOUNT: 119.94
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
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ITEM QTY oTY .DESC.RIPTION UOM- UNIT AMOUNT
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SHIP'D P PRICE
Location: D
ALY1382FO5 44 0l 86 035X44 4SP k LB 2 -726 119.94
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Subtotal j 119.94
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www.india aoxygen.com
email invoice @indianaoxy en.com
j T axable amount:; ;0.00
CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT 11.9.94
3400 W 131ST ST INVOICE: 00513221 THIS INVOICE
INCLUDINGTAX
WESTFIELD IN 46074 INVOICE DATE: 12/18/08
ORDER: 01109059 -00 P /O: SHOP
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))
12/18/08 00513221 $119.94
l 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
$119.94
ON ACCOUNT OF APPROFATIN
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member!
2201 00513221 4 2-311 AO $119.94 i 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
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Wed nes da Decemb r 1, 2008
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?4pner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund