177068 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $9.61
CARMEL, INDIANA 46032 PO Box 76566
INDIANAPOLIS IN 46278 CHECK NUMBER: 177068
CHECK DATE: 9/15/2009
DEPARTMENT ACCOUNT P NUMB IN VOICE NUMBER AMOU DE
902 4359003 08053520 9.61 FESTIVAL /COMMUNITY EV
iR
PLEA ESENDTOPPORTIONVVITHYOURPAYMENT-------------------
t
NV ITEM INVOICE DATE IN VOICE BEGINNING SHIPPED: RETURNED ENDING LEASED BgIJDAYS cYLNDER EXTENDED
P BALANCE BALANCE.._. CYLINDERS .RATE. AMOUNT
D 200 2 0 0 2 1 31 .310 9.61
TAX: .00
CARMEL ART DESIGN DISTRICT CUSTOMER: 21366 TOTAL 9.61
111 W MAIN ST INVOICE: 08053520
CARMEL IN 46032 INVOICEDATE: 08/31/09
TOTAL CYL VALUE: 400. 0 0 P /O:.
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
1 162 -P O S OFT, Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
C/XG/r r o �CJ lyl�i� j
IN SUM OF
�✓c� 78s��3
ON ACCOUNT OF APPROPRIATION FOR
��2 �3s9oo3
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
0, S -20 `f 3 5 96t2 3 �i 6/ 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
2005'
Dire ctor OR Nons
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund