205529 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
0 ONE CIVIC SQUARE LEBANON TIRE AUTO SVC CHECK AMOUNT: $218.99
CARMEL, INDIANA 46032 1310 W SOUTH ST
LEBANON IN 46052 CHECK NUMBER: 205529
CHECK DATE: 1/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 L00483 218.99 AUTO REPAIR MAINTEN
i
LEBANON TIRE AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R T Tire /Auto LEB (765) 482 -5027 12/19/11 04:36 PM
1310 W. SOUTH STREET Page 1
LEBANON, IN 46052
Your P/O A/R Acct# Terms Ship Via
Inv: L00483 L00259 1 ST 10TH
Sold -To: Ship -To: Type Payment
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL, IN 46032
Total 0.00
REP 317- 664 -0958
317 -571 -2615
!R! SCU;UNIT C;BOX 21,.59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
1 1 046100000 carmel fire dept 0.00 0.00 206,220
1 1 046100000 317- 664 -0958 0.00 0.00 206,220
1 1 046100000 SERVICE CALL 85.00 85.00 206,220
1 1 046100000 DIS /REPAIR TIRE 50.00 50.00 206,220
1 1 GY197921050 1.84/195/21L,R24/26 R RF TUBE TR 67.77 67.77 206
1 1 046100000 TRAINING CENTER FORKLIFT 0.00 0.00 206,220
1 1 046100000 BILL JAN 2ND 0.00 0.00 206,220
1 1 046100000 WET, THEY WANTED DRY 0.00 0.00 206,220
SHOP SUPPLIES 16.22
V /Info:
Sub -Total
$218.99
IN GOV'T,0.000%
$0.00
Total: $218.99
NewPymt: $0.00
Total Due: $218.99
Received By: SP:Tom Bailey
IBM
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))
L00483 $218.99
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. WARRA NO.
ALLOWED 20
Lebanon Tire
IN SUM OF
1310 West South Street
Lebanon, IN 46052
$218.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 I L00483 I 43- 510.00 I $218.99 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
jAN 13 1
d
r�
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund