173863 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $743.24
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 173863
CHECK DATE: 6/24/2009
DEPARTME ACCOUNT PO NUM INV OICE N UMBER AMOUNT DES CRIPTION
102 4239011 3274544 -01 743.24 SPECIAL DEPT SUPPLIES
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WHSE DEA# Fed ID: 11- 3136595
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his order has been processed by our MIDWEST D.C.
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
RK 317-423-8784
1 417 -0688 50 /CA ULTRASITE EXT SET STD BOR 4 4 185.81 743.24 1
F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEDING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASEX THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN T`11 RECORDS. IF YOU VE
SED A HENRC SCHEIN "HS") CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY B NEFITS
FROM PURCHASES OF HS PRODUCTS WITH THE CARD III EXCESS OF T OSE BENEFITS IVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI 3CLOSED.
MERCHANDI E TOTAL 743.24
INVOI E TOTAL 743.24
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 743.24
BILL TO INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY
1308571 3274544-01 MARK R nackordered: Item will follow SK School Kit
HIP T INVOICE DATE F BOXES D Discontinued: Item no longer available NC No Charge
P Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 6/08/09 1 P- Prescription Drug: Return Authorization Required
R Refrigerated hcm: May be shipped separately
INVOICE TOTAL PAGE# S Special Schein Pricing
U Temporarily unavailable: please reorder
743.24 1 OF 2 T Taxableltem Continued on Next Page
Prescribed by State Board of Accounts P 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))
3274544 -01 $743.24
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. WA NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$743.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 3274544 -01 102- 390.11 $743.24 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
JUN 2 Z 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund