170912 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $70.06
CARMEL
INDIANAPOLIS IN 46278
CHECK NUMBER: 170912
CHECK DATE: 4/16/2009
DEPARTMENT ACCOUNT PO N INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 08030845 70.06 BOTTLED GAS
I�
c,
v
CYLINDER RENTAL INVOICE
IN -)I XA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
oxylo BOX 78588 INVOICE: 08030845
INDIANAPOLIS, IN 46278 -0588 INV DATE: 03/31/09
317 290 -0003 SALESPERSON: 0 0 0 TERR: 007
BRANCH: 004
P /O:
TERMS: NET 30
B CARMEL STREET DEPT H CARMEL STREET DEPT
L 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 ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED ENDING LEASED gAUDAYS CYLINDER EXTENDED
P BALANCE BALANCE CYLINDERS RATE' "AMOUNT
R 050 1 0 0 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 CUSTOMER: 07851 TOTAL Y 70.06
3400 W 131ST ST INVOICE: 08030845
WESTFIELD IN 46074 INVOICEDATE: 03/31/09
TOTAL CYL VALUE: 1600.00 P /O:
INDIANA OXYGEN COMPANY o P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
N
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))
03/31/09 08030845 $70.06
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
VOUCH NO. WARRAN 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 Memberf
2201 08030845 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
hurscl y /April 2009
Street Commissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund