205647 01/18/2012 CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTC
CARMEL, INDIANA 46032 PO BOX 5219 HECK AMOUNT: $9.95
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CAROL STREAM IL 60197 -5219 CHECK NUMBER: 205647
CHECK DATE: 1/18/2012
DEPARTMENT AC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350100 GOLF 9.95 7003 -7311- 0007 -4683
VF G05 uu SW ''LU .x.
XXXXXXXXX4683
r XXX 1 19:1 4 03878
;i Seg20/004450 APP ResP: AA
t Who
00
Costco 1354226
Tran ID# ID 99034711
PURCHASE
j APPROVED
AMOUNT
000000
0347- 009 0341
.00
CHANGE
ITEMS SOLD REG 9
NUMBER OF p
TOTAL SHARNIECE
CASHIhK 19.19 03Q7 09 034i 5'L
Thanks euR a 1 n!
Please
COS7C® COSTCO
Please Direct Inquiries To: 1- 800 220 -8594
WHOLESRILE
Account Number New Balance Payment Due Amount Past Due Due Date
7003 7311 0007 -4683 $9.95 $.00 $.00 01/20/2012
Billing Date Credit Line Available Credit
12/26/2011 $2,000 $1,990.05
TDD /Hearing Impaired: 1 -800- 365 -0186 e
STATEMENT OF YOUR ACCOUNT
FINANCE CHARGE SUMMARY
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 $.66 0.00000% 00.00% 5.00 00.00% $9.95 5.00 01/26/2012
ACCOUNT DETAIL
Transaction Transaction Invoice User P.O. Transaction
Date Description Number ID Number Amount
12/20/2011 COSTCO WHOLESALE -347 038780 00003 $9.95
00003 SUBTOTAL: $9.95
12/15/2011 PAYMENT THANK YOU 00001 $45.26
Track your spending anytime during the holidays. You deserve to be in control. Log on at www.hrscommercial.com o
HSBC is committed to the long -term success of the company, as well as the communities in which we operate. Our commitment to N
sustainability incorporates not only economic, but also social and environmental considerations.
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Return the below portion with payment. For billing errors or questions please refer to the back of the statement. Page 1 of 2
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Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
iC �TCI COSTCO
WHOLESALE
ACCOUNT SUMMARY BALANCE SUMMARY
CURRENT 1 -29 DAYS PAST DUE 30 -59 DAYS PAST DUE Outstanding
Transaction $45.26
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $9.95 v
60 89 DAYS PAST DUE 90 119 DAYS PAST DUE 120 149 DAYS PAST DUE I +New Fees $.00
Finance Charges $.00
$.00 $.00 $.00 i payments) $45.26 e
150 179 DAYS PAST DUE 180+ DAYS PAST DUE Credit(s) $.00
$.00 $.00 New Balance $9.95
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Page 2 of 2
New address or phone number?
Please check box and complete reverse side.
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Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160, Carol Stream, IL 60197 -4160.
You may telephone HSBC Business Solutions at 1- 800 210 -8115, but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
STMT222C (10/07)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER -CASE LETTERS
AND NUMBERS ONLY!
C H a ❑000000 ❑1100❑❑❑
Email Address
0000000000000000000000000000
Street Number if an 000 St0D 8 ❑0❑❑ Unit or PO BOX Number
CJ ❑00000❑ �s
❑I�
Business Phone
1111 ❑m
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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))
12/26/11 )03- 7311 0007 -46 Cleaning Products $9.95
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
HSBC Business Solutions
IN SUM OF
P.O. Box 5219
Carol Stream, IL 60197 -5219
$9.95
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
7ro '3 731 I &R)3 L "'3
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1207 70,7.311 0007 43 501.0 $9.95 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
I tA
Se materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, January 11, 2012
Director, Brookshir6 Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund