206604 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 00352624 Page 1 of 1
ONE CIVIC SQUARE MARK BAUMGART CHECK AMOUNT: $300.00
CARMEL, INDIANA 46032 C/O STREET DEPT
CARMEL IN 46032 CHECK NUMBER: 206604
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 C291 -05717 300.00 UNIFORMS
002763
DEAR MARK BAUMGART MARK BAUMGART
3040 E 236TH ST jcp.com
Summary 46034
Order Summary/ 1 -800- 222 -6161
317 758 -1620
Thank you for shopping jcpenney.
Invoice No. C291- 05717 Date Invoiced February 21, 2012 Shipped via UPS jcpenney Store 0218-8
Qty Item Number Item Description Price Tax For Office Use Only:
6 RN5834013 560 Jeans -Xt 42 In 36 Stnwsh 300.00 21.00 01 6 A .00
Merchandise total 300.00
Tax on mdse 7.00% 21.00
Invoice total 321.00
Notify customer at 317 -758 -1620.
CUST ORDER# 2012 -0526- 2049 -9940
julia.baumgart@gmail.com
To track the shipping status of your order,
visit our order status page at:
http://www.jcp.com/jcp/accountservices.aspx
321.00 has been char ed to your VISA account.
°Exchanges Returns
We hope everything is 100% satisfactory. If something is not right, please use this form for Exchanges or Returns.
Instructions and Reason Codes are on the other side.
Invoice No. 0291 -05717 Date Invoiced February 21, 2012 Shipped via UPS jcpenney Store 0218 -8
Return Code Qty Item Number Item Description Price Tax For Office Use Only:
6 RN5834013O 560 Jeans -Xt 42 In 36 Stnwsh 300.00 21.00 01 6 A .00
Merchandise total 300.00
Tax on mdse 7.00% 21.00
Invoice total 321.00
01B1628G1
317 758 -1620
Terms VISA 3626 1Z8801520315103979
MARK BAUMGART RETURN LABEL
3040 E 236TH ST
CICEROIN 46034
jcpenney
FULFILLMENT CENTER
Columbus, OH 43232 -4730
pol
Happy Returns.
Any item, anytime, anywhere. It's that simple.
With A Receipt Even exchange or receive a full refund of the purchase price
on the original method of payment.
With A Gift Receipt Even exchange or refund at the gift receipt price in the
form of a jcp gift card.
Without a Receipt Even exchange or refund at the current retail price issued
in the form of a jcp gift card.
Warranted Items
Specific instructions for items being returned for reasons covered by a jcpenney or
Manufacturer's warranty have been included in the package with each warranted
item. If you have additional questions, call CUSTOMER CARE AT 1- 800 933 -7115.
If an item is unsatisfactory for reasons not covered by warranty and you wish to
return it, bring the item and this form to your most convenient jcpenney.
REASON CODES: 11 Damaged 51 Not as ordered or advertised
12 Defective material, workmanship 52 Changed mind, did not like
If a part is missing please call 1- 800 933 -7115.
Order by: (Please make any corrections here.) Ship to: (Only if different from Ordered By)
J c enne Address is: t Home I Business Today's Date Address is: Home Business
p y First name Initial Last
Order Form First name Initial Last
Company Floor /Suite /Department
Company Floor /Suite /Department
Address (No P.O. Boxes) Building /Apartment Number
Address (No P.O. Boxes) Building /Apartment Number
ORDER ONLINE Cit state Zip Code
City State Zip Code
Jcp.com Daytime ]Home[ Business
Daytime I ]Home Business
Page Item Item Number (measure Color /Pattern How One For Monogram Total
N t be sure) Number /Name Many One etc. Price
ORDER BY PHONE
1- 800 222 -6161
Call anytime,
7 days a week
FOR CREDIT ORDERS Complete this section: FOR CASH ORDERS Complete this section: Total Price Enter the
Check only one box. Enter your account number and sign below. Shipping
MERCHANDISE TOTAL and
]jcpenney Regular Charge ]jcpenney Major Purchase Handling
charges
AMOUNT FOR SHIPPING HANDLING for the
total
I Visa MasterCard American Express I Discover Card SALES TAXES merchandise
value.
TOTAL PAYMENT
Expiration date: Month Year
Please pay by check or money order in U.S. dollars. Sorry we do
not accept C.O.D. orders. Do not send currency or stamps. Include
payment for shipping handling.
Signature (Required for all charge orders) Date
For orders to Alaska and Hawaii and all USA Possessions and Territories, we will
ship via Parcel Post unless you indicate Air Parcel Post here. Air Parcel Post
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))
02/21/12 C291 -05717 $300.00
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. WARRANT NO.
ALLOWED 20
Mark Baumgart
IN SUM OF
3040 E. 236th Street
Cicero, IN 46034
$300.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 C291 -05717 43- 560.01 $300.00 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
Mon F Gary 27, 2012
Street Commis i er
C�ract (`r.rn oc� n�.
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund