176282 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 CHECK AMOUNT: $70.06
PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 176282
CHECK DATE: 8/19/2009
DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUM BER AMOUNT DESCRIPTION
I: 2201 4231100 08047669 70.06 BOTTLED GAS
CYLINDER RENTAL INVOICE
INDIANA INDIANA OXYGEN COMPANY idl_ S U_
TOM 0 7 8 5 1 PAGE: 1
P.O. BOX 78588 INVOICE: 08047669
W.
INDIANAPOLIS, IN 46278-0588 KiOVAE� 07/31/09
317-290-0003 SALESPERSON: 0 0 0 TERR- 007
BRANCH: 004
P/O:
TERMS: NET 3 0
B s
CARMEL STREET DEPT H CARMEL STREET DEPT
3400 W 131ST ST I 3400 W 131ST ST
L WESTFIELD IN 46074 P WESTFIELD IN 46074
T T
0 0
INVOICE AMOUNT: 70 06
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
INV BEGINNING S C YLINDERS IJ
ENDING BADAYS
TY ITEM INVOICE DATE INVOICE HIPPED RETURNED CYLINDER EXTENDED
aE BALANCE BALANCE --RATE. A
R 050 1 1 1 1 0 31 .310 9.61
R 11X 1 0 0 1 1 0 .310 .00
R 147 3 0 0 3 0 93 .340 31.62
R 220 2 0 0 2 0 62 .310 19.22
R 330 1 0 0 1 0 31 .310 9.61
TAX: .00
CARMEL STREET DEPT CUS MER:-07-851. 70. 06
IOTA
3400 W 131ST ST INVOICE: 08047669
WESTFIELD IN 46074 INVOICIEDATIE: 07/31/09
TOTAL CYL VALUE: 1600. 00 P/o:
INDIANA OXYGEN COMPANY e 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))
07/31/09 08047669 $70.06
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
VOUGHER NO. WARR NO.
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$70.06
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member
2201 08047669 42- 311.00 $70.06 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
Thulr day V�4u st 1 009
i 7
St reet .C,pmmi.s ,,r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund