205975 01/31/2012 a \,f CITY OF CARMEL, INDIANA VENDOR: 00350983 Page 1 of 1
ONE CIVIC SQUARE R T TIRE AUTO NOBLESVILLE CHECK AMOUNT: $567.64
CARMEL, INDIANA 46032 17016 CLOVER ROAD
NOBLESVILLE IN 46060 CHECK NUMBER: 205975
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 N006NH 567.64 OTHER EXPENSES
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Store Location Store Phn Date Time
R T Tire /Auto NOB (317) 773 -3130 01/13/12 01:30 PM
17016 CLOVER RD Page 1
NOBLESVILLE, IN 46060
Your P/0 A/R Acct# Terms Ship Via
Inv: N006NH N04158 1 ST 10TH
Sold -To: Ship -To: Type Payment
CARMEL WATER DISTRIBUTION (E09
3450 WEST 131ST ST
CARMEL, IN 46074 -8267
Total 0.00
ARC 317- 733 -2855
r 317- 716 -3909
Qty Shp B/0 Item Number Description S/W °FET Price Amount Init's
4 4 GY748747188 LT245/75R16 WRL SLTARMRf$PROGRA 136.66 546.64 5,418
v=
4 4 EPA STATE., TIRE FEE (INDIANA) 0.25 1.00 5,418
4 4 041263000 NEW VALVE�STEM 2.00 8.00 5,418
4 4 093002000 Pb 3.00 12.00 5,418
V /Info:
e Sub -Total
$567.64
;3 s
Sales Tax
T $0.00
Total: $567.64
NewPymt: $0.00
Total Due: $567.64
Received By: SP:Chuck Godby
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
350983
R T Tire Auto NOBLESVILLE Purchase Order No.
17016 Clover Rd. Terms
Noblesville, IN 46060 Due Date 1/23/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/23/2012 N006NH $567.64
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
Date Officer
VOUCHER 113503 WARRANT ALLOWED
350983 IN SUM OF
R T Tire Auto NOBLESVILLE
17016 Clover Rd. TER
Noblesville, IN 46060 OP71OiNS
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
N006NH 01- 6500 -05 $567.64
Voucher Total $567.64
Cost distribution ledger classification if
claim paid under vehicle highway fund