179537 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
ONE CIVIC SQUARE CRYSTAL FLASH PETROLEUM
CARMEL, INDIANA 46032 PO BOX 105080 CHECK AMOUNT: $44.74
ATLANTA GA 30348 -5080 CHECK NUMBER: 179537
CHECK DATE: 11/24/2009
!DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 15504 44.74 GASOLINE
CRYSTAL FLASH #67
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I
5 RANGLI INcL R-Du
CARM'IEL., IN 46032
f
317-&
9185701^145-0 1 1 A 17
0 CRYSTAL EHo I D i
E RD CARMEL b S RANGE] IHILE
Desc r. 431 -F,imount
P1 TCATr ifFrETPT
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35
A #O J, Q
4
C'.
4
7-b To 4
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1 0 P
TOTAL 44-74'
MAN CRED IS
WEE APPRECIATE YLEIUK
BUSINESS
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C{ A R !R E f E E r-� A� UPI 6F CHA'FiGE'
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TIlIP CHARGE TO BE ASSIGNED
,i� d C i 5,'•- e ,ADTOTHEN BE PAYABLETO
SOLD e Crystal FIas Petroleum lndpls IN
A 1� y` o A to, the Issuer of stied other
CUSIMER COPY- PLEASE.RETAIN THIS CO� TCi.�RIFY BILLING.'
SOLD i DATE approved
BY credit' card as ised
making IN urchase THANK YOU, a
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W
t r `A}f�` M f Customer'ack edges the edn used m
[I 'i f+' L. !t C h� P�� Y �Q'!. E l N thi urcha s un evoked a t agre p r
thi urch a upon receipt of 1 m It:
I/*;.. t�� !y t a
an w0h the 1666S
of the
1_43�•1.i tit a ent overniny, the use o' cli cant S
r'k ROBUC c' OUAN UNIT PRI E 'I A OUNT."
GASO "DIESEL O i
CUSTOMER SIGNATUR r
KEROSENE AUT 9RIZATION ATTENDAN 1
f INITIALS
DRIVER ID ODOMETER
TAX
EXEMPT TOTAL' 4'
NO!, I' VEHi� N0. trj„6tp /wry
ALL APPLICABLE TAXES'INCLUDED
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))
15504 $44.74
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
i
VOUCHER NO. WARRANT NO.
ALLOWED 20
Crystal Flash #67
IN SUM OF
545 S. Rangeline Road
Carmel, IN 46032
$44.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
j
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 15504 42- 314.00 $44.74 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
�7 'Z 1
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund