205481 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC
CARMEL, INDIANA 46032 PO Box 1106 CHECK AMOUNT: $449.21
NOBLESVILLE IN 46061 CHECK NUMBER: 205481
CHECK DATE: 1/17/2012
DEPARTMENT A CC O UNT P O NUM IN VOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 71810 27.03 REPAIR PARTS
2201 4231300 GT020051 422.18 DIESEL FUEL
DEPT.
NO I II I 1 /o 71 10
MO. DAY I YR.
ami ton
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COUnty o
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FARM BUREAU COOPERATIVE N E
ASSOCIATION, INC. o
P.O. Box 1106 0
16222 Allisonville Road
Noblesville, Indiana 46060
CHEMTREC :11 11
SOLD BY CASH CHARGE ON ACCT. MDSE. RET TERMS
CITY DESCRIPTION MIN. COMM. UNIT PRICE AMOUNT
V
I
r
SUB TOTAL 7
SALES TAX ON
Received By �`O c?7 0
TOTAL
Additional finance charges may accrue at the rate of 1 per month (21 APRO)
it payment in full is not received by the 30th. Minimum $.50.
FERTILIZER/PETROLEUM GRAIN MERCHANDISING SHERIDAN HORTON ELEVATOR
776 -4143 773 -2685 758 -4181 758 -4463
SALE 5741 DATE 01/05112 15:51:19
COUNT: START 0.0 END 126.4
GROSS DELIVERY 126.4 GALLONS
4040 DIESELEX ULS UN DISTILLATI
MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO-OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000031175 Invoice GT 020851
CARMEL STREET DEPT Date: 1/5/2012
3400 W 131ST STREET Time: 14:42
CARMEL, IN 46074
Tres Terms Description Item Description Legend Quantity Unit Price item Total
01 NORMAL 154040 DIESELEX ULS UN 19 E 88.5000 3.31000 292.94
01 NORMAL 124029 HEATER OIL-UN 1993 E 37.9000 3.51000 133.03
01 NORMAL 194070 PETRO VOLUME DISCOUN 126.4000 0.03000 -3.79
Legend: Invoice Subtotal: 422.18
E- Netered, T= Taxable, Entered by Hand Indiana Sales Tax On: 0.00 0.00
Invoice Total: 422.18
DARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT i -800- 424 -9300 WE
APPRECIATE YOUR BUSINESS!!!
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))
01/05/12 GT020051 $422.18
01/10/12 71810 $27.03
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
1
VOUCHE N W NO.
ALLOWED 20
Hamilton Co. Co op
IN SUM OF
P. O. Box 1106
Noblesville, IN 46061
$449.21
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Member
2201 GT020051 42- 313.00 $422.18 1 hereby certify that the attached invoice(s), or
2201 71810 42- 370.00 $27.03
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
�///Wednesday, Jawary 11, 2012
U0 �1
Street Commissloper
vu cGt vViiUI IIJJI II I
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund