171872 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 129000 Page 1 of 1
ONE CIVIC SQUARE HOLDER MATTRESS CO, INC
CARMEL, INDIANA 46032 130 W MORGAN STREET CHECK AMOUNT: $1,579.80
q N KOKOMO IN 46901 CHECK NUMBER: 171872
CHECK DATE: 4/29/2009
DEPARTM ACCOUNT PO NUMBER INVOICE NUMBER AMOU DESCRIPTION
102 4463000 CTF09 -2 1,579.80 FURNITURE FIXTURES
c
Holder Mattress Factory
Built for Comfort Designed to Last
Since 1947
INVOICE
Invoice Number: CTF09 -2
Clay Township Fire Department Date: 4/18/09
2 Civic Square Terms: Net 10 Days
Carmel, IN 46032
Item• Description: Quantity Item Price Total Price
#1 Expression XL Twin 4 $379.95 $1,519.80
92 Delivery 1 60.00 60.00
Invoice Sub -Total $1,579.80
IN Sales Tax 7% EXEMPT
Total Invoice Due $1,579.80
Payment terms Net 10 from date of delivery
Delivery Confirmation Attached
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236 -1492; Fax (765) 236 -1495
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))
CTF09 -2 Sta. 43 $1,579.80
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Holder Mattress
IN SUM OF
130' -West Morgan Street
Kokomo, IN 46901
$1,579.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 CTF09 -2 102 630.00 $1,579.80 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
APR 2 7 2009
Fire Chief E
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund