171902 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 362831 Page 1 of 1
ONE CIVIC SQUARE JAY ORNER SONS BILLIARD CO INC
CHECK AMOUNT: $100.00
CARMEL, INDIANA 46032 6333 ROCKVILLE ROAD
T"�FuH'Zo INDIANAPOLIS IN 46214 CHECK NUMBER: 171902
CHECK DATE: 4129/2009
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION W
902 44.60805 100.00 SHUFFLEBOARD
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1' r JAY CRNER SONS BILLIARD CO,, INC. l
6333 Rockville Road Indianapolis, IN 4 6214
(317)'243 -0046 fax (317) 247 -7743
www.o3nerbiIIiardS.con3 Y /r o 7
NAME r 16 DATE Il
ADDRESS �5y Jy ce id i
CITY C r rn L Ll 03�-
mo7 31.7.. ao5 -7030
HOME PHONE# WORK PHONE#
TABLE SIZE
8 OS 1 91 W r
WORK ORDER ESTIMATE(VISUAL) ESTIMATE(PHONE)
RECOVER ONLY
SET -UP ONLY
SET -UP RECOVER ONLY
DIS- ASSEMBLE ONLY
DIS- ASSEMBLE, MOVE, SET -UP ONLY
DIS ASSEMBLE, MOVE, SET -UP RECOVER
RUBBER CUSHIONS
ESTIMATE rD
LEVEL rn (x 4C b
COLOR
MODEL:
SIZE: MFG:
COMMENTS OR ACCESS
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SUB TO TAL
IYRECEIVED BY '7" 0 SALES TAX
TOTAL v
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
CO. -Z'e Purchase Order No.
j 33 Terms
y G �y Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
IN SUM OF
n
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
9Ou' Y15 i" 60e5SU -6v, c, 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
2 ;7 20 0,9
J� Signatur
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund