206834 02/28/2012 CITY OF CARMEL, INDIANA VENDOR. 354734 Page 1 of 1
ONE CIVIC SQUARE TOM O'BRIEN CHRYSLER -JEEP
a CARMEL, INDIANA 46032 4630 E 96TH ST CHECK AMOUNT: $10,663.80
INDIANAPOLIS IN 46240 CHECK NUMBER: 206834
CHECK DATE: 212 812 01 2
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4465001 25937 10,280.00 DODGE GRAND CARAVAN
1110 R4465001 25937 471338 383.80 DODGE GRAND CARAVAN
168466 471338''
*INVOICE*
CHRYSL JEEP
CITY OF CARMEL
Our family works for yon. Since 1933.
ONE CIVIC SQUARE Page 1 4630 E. 96th St.
CARMEL IN 46032 Indianapolis, IN 46240
HOME BUS 317-571-2534 (317) 805 -4440
www.obrienauto.com
CELL: SERVICE ADVISOR: 319 MERRILL FIFE
COLOR YEAR 1VIAKEIMODEL V1N LICENSE MILEAGE
PAV Ch 12 DODGE CARAVAN 2C4RDGCG7CR132048 154/154 T773
DEL.DATE ..:PROD. DATE: WAR R: EXP PROMISED PO NO RATE P,.AYMENT INU DATE
20FEB12 1 17:00 21FEB12 1 0.00 1 CASH I 21FEB12
R. 0:. .OPENED READY: OPTIONS:STK: 22003 DLR: 6 18 84
ENG:ERB 3.6L V6 24V VVT Engine
15:04 21FEB12 .15:16 21FEB12 TRN: DG2_ 6- Speed _Automatic_62TE_Transmission
LINE OPCODE TECH TYPE HOURS LIST NET TOTAL
A CREDIT FOR PRIOR RO #471326
KEY CREDIT FOR PRIOR RO #471326
99 INT (N /C)
2 5604670SAD TRANSMTR INTEGRATED KEY FOB (N /C)
-2 68029829AB KEY -BLANK (N /C)
PARTS: 0.00 LABOR: 0.00 OTHER: 0.00 TOTAL LINE A: 0.00
B CORRECTION IN CHARGES FOR 2 KEYS, QUOTED $192 PER KEY, PARTS /LABOR
KEY CUT /OR PROGRAM KEY AS REQUESTED
99 CPA 20.00 20.00
2 56046705AD TRANSMTR- INTEGRATED KEY FOB 147.00 147.00 294.00
2 68029829AB KEY -BLANK 35.00 35.00 70.00
PARTS: 364.00 LABOR: 20.00 OTHER: 0.00 TOTAL LINE B: 384.00
Award Winning 'FIVE STAR' Dealer -Since 1933!
LIMITED EXPRESS WARRANTY p$GRIP710N i TOTALS
Labor and parts are warranted for 90 days or 4,000 LABOR AMOUNT 2 0
miles whichever occurs first. Tom O'Brien Chrysler
Jeep North hereby limits any implied warranties PARTS AMOUNT 3 364 00
of merchantability or fitness to the same period and GAS, OIL, LUBE 0 00
Tom O'Brien Chrysler Jeep North neither assumes SUBLET AMOUNT 0 00
nor authorizes any other person to assume for it MISC. CHARGES
any liability in connection with the sale. 00
TOTAL CHARGES 3 8 4 0
LESS 0 0
Main 1317) 605 -4400 Body Shop 805 -4460 SALES TAX 0 00
Service 805 -4440 Leasing 805 -4430 PLEASE PAY
Parts 805 -4450 THIS AMOUNT
Service Materials: A charge been made on this repair order for materials used in 1,,rvr+�
repairing your automobile, such as, nuts, bolts, washers, welding rods, tape, cotter CUSTO COPY
pins, aerosol lubricants, solvent, rags, carburetor cleaner, solder, battery cleaner,
wire, window sealer, hazardous waste, etc.
168466 DATE OF DELIVERY 0 2 S \12 I D ri 168466
CM OF CARMEL
Jeep TV IV, 0 fl rIt IV IC SQUARE EMAIL
qAM N k
I hereby order from you, subject to all terms, conditions and agreements contained herein,
CITY COUNTY CELL PHONE
and the ADDITIONAL CONDITIONS printed on the reverse side hereof, the following STATE AND HOME P oN E1
WJ NEW O DEMO USED VEHICLE: ZIP CODE I 46Q32 (31 f 5/ 2534
YEAR Znl; KE MODEL
20 ig C FINANCIAL STATEMENT
TYPE COLOR BE DELIVERED ON OR ABOUT SALES PRICE 22321.00
PAWDK. CHAR Tl
02 \15 \12
STOCK NO. SERIAL NO. STATE SALES TAX B \A
90 0 3 I R 1 3 2 0 4 1 8: DOCUMENTARY FEE B\A
Al It
CC ,LlCE�1.SE:EEE: EXCISE --A•X s 280.00
Ivf I S0- �S golf
i ICE 22321 SERVICE CONTRACT B\A
GAPINSURANCE N \A
S
DIFFERENCE 22321.00
ri KTO NER STA TES ANY AMOUNT OWED I IERED v
TRAD ow VEHICIE IN EX CESS OF
S CASH D I I
s A mni INT To THF RT E !U {1
E T T 14F MFR T I p(�i��' I
L I 'V
E TRADE -IN AI v 1 A
CU ra Gc T F M
E BALANCE OWING TO: N• N n
TITLE FR E E f1 C G A ll N LESS: I� (V V�
T CASH DUE ON DELIVERY U
v
ODOMETER DISCLOSURE STATEMENT
W E R Yn
b WI a r Federal law (and State law, if applicable) requires that you state the mileage upon transfer of ownership.
A T IN YOUR ID 1 CU Y T T V Failure to complete or providing a false statement may result in fines and /or imprisonment.
t I 111T I, TOM O'.BRIEN CHRYSLER JEEP DODGE RAPS
state t at the odometer now
C HR YS L ER E (TRANSFEROR'S NAME PRINT)
reads (no tenths) miles and to the best of my knowledge that it reflects the actual
r -r n V N i mileage of the vehicle described below, unless one of the following statements is checked.
u n r R n r T M u
CHRYS r t R P WARRANT (1) I hereby certify that to the best of my knowledge the odometer reading reflects
R E r the amount of mileage in excess of its mechanical limits.
(2) 1 hereby certify that the odometer reading is NOT the actual mileage.
WARNING ODOMETER DISCREPANCY.
TRADE -IN CERTIFICATION: I hereby certify that my vehicle which I TOM O 'BRIEN CHRYSLER JEEP DODGE RAM
am trading in has never been titled under a State or Federal "BRAND" TRANSFEROR'S NAME
such as "DEFECTIVE," "REBUILT," "SALVAGE," "FLOOD," ETC. 4630 EAST 96 STi rET
TRANSFEROR'S ADDRESS (STREE
X (initial) I DIANAPOLIS, IN 46240
(CITY) (STATE) (ZIP CODE)
DESCRIPTION OF TRADE -IN TRANSFEROR'S NAME x SIGNATURE)
C
YEAR MAKE MODEL TITLE NO. 02 \15 12
c DATE OF STATEMENT
COLOR SERIAL NO. TRANSFEREE'S NAME CITY OF CARPiEL
ONE CIVIC SQUAR c NAME)
TRANSFEREE'S ADDRESS (STR OTA RMEL IN 460
The information you see on the window form for this vehicle is 4
(CITY) (STATE) (ZIP CODE)
part of this contract. Information on the window form overrides TRANSFEREE'S NAME
any contrary provisions in the contract of sale. (SIGNATURE)
(PRINTED NAME)
DISCLAIMER OF WARRANTIES
H A I A Y RH t I IP Y I I The manufacturers warranty constitutes all of the warranties with respect to the sales of this term. The seller,
AiESMAN hereby expressly disclaims all warranties, either express or implied, including any implied warranty of
APPROVED BY
merchantability or fitness for a particular purpose, and the seller neither assumes nor authorizes any other
THIS ORDER IS NOT VALID UNLESS SIGNED AS ACCEPTED HERE person to assume for it any liability in connection with the sales of the product.
LIABILITY INSURANCE COVERAGE FOR BODILY INJURY AND PROPERTY DAMAGE CAUSED TO OTHERS IS NOT INCLUDED.
NOTICE TO THE BUYER. Do not sign this order before you read it or if it contains any blank spaces. You are entitled to an exact copy of the order you sign.
BUYER ACKNOWLEDGES he has read and received a completed copy of this order comprising the entire agreement affecting this purchase, and that this order
is subject to acceptance of Buyers credit rating-and amount to be financed by lending institution.
BUYER GERTAFIM e is of a al age to execute binding contracts in this,.State, and no credit has been extended except as appears above.
A. Buy Signs' �J B. Co -Buyer Signs
(i n% X
11 9/10
MITER
This ride isa:s*aumReaVinstal!mcnt �,a|euC*o:act, and eiMe/ has been`mwi|/uemadea part m snici wx tuge6'anysbrtpon, troct he/pnn^
T0wosn/swCunvausRKsp DODGE ^SOwKan,we1eaw,r. Iunommp/meNeo purtkase I Me"emm*uevmmouon-ic�?vanu/nammu,rmaorimmv
androms|ies that Se|e, may have rp'ein below. Seoo,e*oU have a|/1xm and mrl«gii� se! uxm|n said /o|a"'wJnhxy�emo
1, Appiivaitiou: Ao the time o/vuxarn/gningofn`*Rmax|ommxmem Sales (»ntra�,,orup:ouc'|veolu/mrv')Nceues6ibo�,`arn.s�'�o,,emmuxao�o
Scher aureditapp/kmnuo, Buyer wwmmts Ma On appka writains Baye& entire xh/ Jmv MemhrmwmmcowmecioeA/'/sx,�cones am
oomv/e,e�Bvyoni�,- W SOW m now `mnM8A/*xdiva/yoro`evomc|ouesr,ivauhm' sa|a
Ime&/vyA3e||o,mvaiy the truth cr)daocur-aeyurthe m*nnat'o:ovnmmeu m syWQrm(jit up;kao:^'ano m u/ Sty myw`o.n=mi/ye
de|*o mi-eof,marff, any (it the 'nfonnaiionmrrichrd r, Buyer /ohonWWuefa|oe.u^oyen,inoumpi Buyer d`a/bocoonUvnomwymu^huu and Saxe,
niay.ati*volsopm\dwo|yeMannoeu^/anoo (file vnmed'mo|y.u,,eqoie Buyer m return seiu,ux|n|oo^o pay aoxeru|,v`upnm,z! oi m
ogoK*mKarmwuoe,moayacxayem$4oMOpo, day voowasonabwm`a'ge hu u mmevemoe
Zp/ame`omn/a,Rmmoimq/mmo*vaMmKove"mpughB:yw'xc,ouuinfo/rmuonisWunumumemu,a(y.rmsanguomp/efe,uu[io,ur.vrfonwnx`cSu,ais
uxa*�yomio ma daxx(pm the &,ta horeofmsoil, nmmfero,mxnmvuer 01e10 rumMIT! Mzoy :aM'nD o:mMo o,xSunbmi:ne:gmomd in K'
Wsmr"xno(5non'Ongmnoubja* matter v,diisuuntraci then. in that ev�mSe|bromnx/ia,oVe Way to Tmmmuimpt;ranuy:enmi*pu=»owvepeuys
wd Sn|wanu Buyer WWI upm demand by 3e||e,imn`edivte|y ,em,n,ho xaWv*m6om3ex*raA Svoe, axan 'nnxn In eoyo,nx u/ou;K,ua*ct»h |enzvy
o of vaWe of mici v0de, aM in idm MTudSaL@per day uo x|m /h m"no^onwv ri1e
oimutyvLeao*w-ov*uma,!mamsnL-,:^ said oon,,mlo*N|ve'e'x,nmo&x'a.x`uemmad and aV/ood mopz'xe^ua�Sa/w'expm»�v'esonos
me hgumvuup8mo.wmnmnnwp. a Nname oo!ripany other than that spamoedio the mwummtnw.av lo-rig as, Remnuno/ n,apw,go5 bond mj,/
mna'o,Menam*.o Buyer Us remimxewhide Man SdWrmayexaT'sea:hyhs and eme%5 m*:uhie a,Wwand ^nsnuiy.odu@o»to 'j+z/tocm+m
dojn��a� below,
3. i Buyer un( that Sao does not provide i,uunmrpuxairvQ Wow M*10 0 posusobn Mom vowur e."r.x,ns»om%0r,o,.^a
x`unwnvon/mmem:/osno.uys/gnamre./m'emcnm,n,Buyer and wa,ra*tsmu*xc,MAnyu him i,%/somcnvomq Ti unoormoyou,.zuv~
furtirt/agrees to be respomullf) for payrrient of any denudibie im;urance experise incurred by o|mjm Buyer r,imm*ouin'�na,�iuo,*
A xm&'/n' agerohwx pay an u*'nanu avvdi*ersi^va matweep ws amount of On on Vie car n,:*nicm baion tn`uou anuma p n wc`m'm a.p*'
warmt Mat U aar/ums/xa,au has /x^'.0 W m
muinamy iosell arid Mal mmream'voiie^.cww5v'mnc"nmarimamonapy*xosxao*m"*`,o/momnNmh,ws av''
agmes m moron good and tie 1cmp'mvehidommeumtily upon being Ad W or �gon 8/yy/v`mo,:M '�+^o.o V»em
_'Os not carry Vexeslgneuon^Sx.o,Reboi|rasmyinoumgAoaM Vie }nmanaRo,sauS)iaujtvu,m:, does il�e,/nk�:yn/ fry u;s'ycuxw`'Saconxt.*n'
5. buyer's C made by Buy,- to'seller Proves m be n,i{ tee K any oms'umacxo/m, sw-anuyTi",''nve
�o»o
upon oe*anu uySe}le,, te.iumoa/d m Seller af Seliero phwe of Bomioey |r Buyena|a Z(' fe!"'m nam v,wu|e w eu":,�uwm/=s n.0
enripowers Se,ew|ts not t hisfuity fropmess oom vehicle *m or wk /pmce" and m '0oue*anu "seJ.c.^
ve:ic|e,'ncmmor'nu,s and aLw,nmvo fees and costs mm^narnan with o`pwn(rmon`nntv'm/oag'o*'``em.
6. Receipt cvo^ucmmnts'ouvnrudmnw|eu, oeue!p/oferopynfMo8uya,5 Ord^�ucopvg|maionn Cooxaoa,!omilsnr�'
7. Liqwidww�tuoamaVc*-|naddmonm all ahe,'ani.ageauue600e,xewu.,Vmupon8yy:.^vur�!vx. *xo'mn�"m"mn."n'`"xnw��ru�.q`m*
xarewuwpa/daoado�npyyrrienImmtt-onwinobyeWmxWiuoxaf/r. buyer xemuywa'"puo"Wwoon*Y.rAw to swd sumi n/':u,'vard'w mno.y
v, RmxmDeiaou|nMaa.enmBu oemwl.,emu^uer Buyer aVmw:u^aouo Vie "how urvmoBon w`����u,uaur��/*aa*°an;
nqw.n*e.m, Interest in,anoIo.5amvoman'
x it- +urm noarsmou and reeu:
Tine order nn in* e, rse' s!de n�enf mnu"iowm the w1owmgwnoeundnonuio*'wMxKI-iMal boenmxiuu Yxy/osg'pmy
P. Tha
11xmo used ,*ome/x not m»edo/�wegun:!tmga|'«pry of Mmnnrv0ido,mo^nedvax`mwxhwwereappouona, noneanJyuu�l "�ijo stai/
detormine/xea|wwaov*�oado far such ,mliio|o used Thouuyo,apeoymuc|werthevhg'na/h|Uo/w4mxAmonUoAaWuno -dude ma*uxnnina|vxg`,.m
!he ge|*e�',)Ixu�;*mhido,a6mebvyorvanamommK used ,didstu»o his orupnmy fret and i�|earo(oV liens. "nu uoshw"~'sp�mad
wem/n.
1pon am koi|ueurosuua|t),'mebuyeovcwnpmiea said purchase twanvwasvnoxe,,hanmm:g:m/u^ovacco"n,v/mvaosoinprica.o`poa.x4epoexnm?
mamm|' va�d mMaevon�aus�vehdexe been �xenin/�dv.m*uo��,xeeuyayUhnoz�suou/mr�xounaWve�6eanuXm�*/�,
xnax ue �i/vV/|ed m re/muvoe mmuenoutnfu`o proceeds of such ouie, for the pxpena*no»mmeei m vasgfmp^ aabn*o ard *|ou ;nr h}* ong `�uump
//ic,naun,svncreuaen`ems"xoruoye,'s/ax",vtn,omn/n,eswmPurchase,
1e r tie �anu/a:m/P,huema^gmm make any ohango'�'nMe model nrd n»aocamvrku and pal ofmv now amu,vnuewa,nomrv�ro*Wumo^g
env obl|naunn on to pn,/ of Mtn me ooa|n, :r me Mauuiacmle,' to maffe oxa:gpu .o %!'le vomda cow^f("("' by nrdoro/me, r��foe y'
ou�oyquyn w"mooe/wewmoumvrnO.Iaw the buyer,
/o,om/p, flat oo liable to, domvsc,-mneduyma^mnummu,",.oromema,nureuo&mr%n,othe,cmuvPmv^,o.`u the cnnxmm!,' n�a/*`.
`4, The p;Ge of tmo vewwo qv^mo berein uuoo not /cmUde any taxes, unv mm auiburity nv, to, oi a`mo omo o� ue/*envm su:h
unless exp�essly auxlrwed,»WWeIbvye, assumes and o0nrn/o pay unocuapmmmwd s?|uw. any /exoe.oxpommoomemxo'i'npva:dunmrinuuaymwn`e
oansa��m��m�m',egam/aws of pnmon having the p/in`aw tax nwbouy-
O0����������7���������Ui��
'15 THE 104NupaoruRsR'S W4RmAmTVcomsrn/reS ALL mp THE mmMRxmr/ESm/Mwm:3PerT SAU'_ mso,rm,'�i S���s� �om
�,*nvmusm JEEP. INC, HEREBY S:pREsSLY ImS ALL m/AxmmoT/sS ETHER F�tpn-'ESS OR umo /�puso
vzonmAmrvOp mEnsvoAmTAaxu) ,oP rnmeoS FOR PARn3uLxm punpCfss THE een*haAmsu�v'so m3R AoTRoA/rasm^7
07*EnPsPSOmVo ASSUME Fomn ANY LIABILITY xmCONwcCmOm )WITH rweSaUFof
NO WAP iANTES EXPRESSI..*o OR WPLIE[), AaE MADE BY RE DIOR WITH RESPECT R) USED MOTOR VS /|oi.!H 0R.'iV01 Of 3vsH./oLsCHASSIS
punn|a|'/Eo*sRsumosn EXCEPT AamAYos EXPRESSED |mvvmrlwa 6\ T/ 1s osVEn FOR auo�
c*asS/SvvmoHwmnPowT.. IFGOsxpasG8so/wVxn/r/ma.m/wConpoRaTeo HERON AND MADE x PART nensoZ
"Km case *nvehw|evnvmmuu miu order |au used vehicle, no f)|mpreoenmivnis osmnm =AM o/am/`wo`mn has over uyou.'eno'ubnvn:
MmnnWaVe shown onmevpovummete,u{ said used vemme.
1r,inma event mul the mwmu order in not acash Zronsucnmn,v`ou,rorhp:_ before ovu/mu toe A,0vu.rI Ohmxan/e^Knkar.(;
/nam,mmywin`me knnx mid ,mnudivnacfp:vmmzs Au.:axxonmphnnof Miinn�ei,mxcx^uxewAw acma*/meivag:.ox`c/xcna|ua/e usual, '-f
o��), �rrn ofoiurity 6gmenmM asnmy be reqmind to coonmWwIts 4anowhonwon aure:wg/pnonDays,
`a This ato,*m/Noc, to awWWnce uymege/s, em` 000nmmm uha|! ues/VnKAd by Ax s|g/nmy,p o/ To Dea/sv mnme/: mwogm or of a..xn,',nu
aiw`*m�oom*n"Veme side *amo
IM OLD NATIONAL BANK* 1158535
Your b8n7 For fife
REMITTER HIIANCH p L� PATE
71 -11863 1
I P• J08LESVILL�4UTi� .LEA r'CJr +Ja_ry'll� �p� I
I
PAY 0 o R o T T -j 1l G B R I N 0 6T1 C' F C R M F $12,321 QO
A
I
I,
CASHIER'S CHECK AME AND TITLE
I, J �14N
PRINTED NAME AND TITLE j
II° b b 58 5 3 Su° 1:0863000121: 11 2000 70 511°
ANCE JI, MC
ronlDbUMf Mai S
hcw,p Ca ,el
N^MM PRPSTIGE20JlCLVE C�
o o
o�
CHRYSLER JEEP
4630 E 96th St
Indianapolis, IN 46240
(317► 805-4400
vvww obrienauto com
168466 28638
TOTAL RECEIVED- $12,321.00
CITY OF CARMEL DATE-TIME: 15FEB2012
ONE CIVIC SQUARE CASHIER: BRANDI
CARMEL, IN 46032 LOCATION:
Serving your Family since 19331 CASH DRAWER-.
.COMMENT
ACCOUNTING DISTRIBUTION Mzi; aRin
Co A C C 0 -AM OU N CONTROL =C0NTROL2
1 56 1 '10309_a 12,321.00
1 11100 -12,321-00 168466
Sheeks, Cindy L
From: Anderson, Teresa K
Sent: Tuesday, February 28, 2012 11:48 AM
To: Sheeks, Cindy L
Subject: Van and extra keys
Attachments: Tom O'Brien.pdf
Here's an e -mail and I've attached the check and another form. Let me know if these will work.
7'�4 e,s� A nderso
B t 'A
Ccx.+-PTLe4/ CW HWAI:t
3 Uvi�5grwwa
Ccu- wu?,L, IN 46032
317 -571 -25.59
317 -571 -2512
From: Goodman, Leland C
Sent: Tuesday, February 28, 2012 11:39 AM
To: Anderson, Teresa K
Subject: FW: Van and extra keys
From: Philip Hathaway ma i Ito: phathaway(ftbrienauto.com
Sent: Tuesday, February 21, 2012 10:39 AM
To: Goodman, Leland C
Subject: Van and extra keys
Major Goodman
Here's the break down on the van's pricing:
$22,321.00
280.00 Misc. accessories
383.80 Cut and program 2 extra keys
12,32 1.00 Payment Received
$10,663.80 Balance Owed
Our parts department just got in the key fobs this morning, so let me know when you want to bring in the van.
Our service department will need the van and both of the keys you already have, as they need all four keys to
program them. We can shuttle your driver back to Civic Square if that would be more convenient for you, rather
than have the driver wait 45 minutes or so.
Thanks
Philip Hathaway
Tom O'Brien CJDR North
Indianapolis, IN
317 -805 -4428
i
INDIANA RETAIL TAX EXEMPT PAGE
C1 of CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
ty
�+s
FEDERAL EXCISE TAX EXEMPT 2
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, kP
CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
92199
Yom O'Bdon CDJR Nafth Camel Police CepaAment
VENDOR SHIP 3 CIVIC aqum
48M E. 28th SI:Iot t TO Cmfmal, IN MW
Indimapoll$, IN 48240 679
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 444M.0
1 Each Dodge Grand Caravan $10,663.80 $10.663.80
Sub Total: $10,663.80
�tT
s
c ',("n
Send Invoice TO: I
Cume Pcllco Daplfl ono
Aftn: Tarosm Andoman
3 CIVIC squaw
C @mol, IN M° PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Camel Police Dept. j PAYMENT $9Q,
A/P VOUCHER CANNOT BE APPROVED FOR'PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND'EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE )N
THIS APPROPRI T
SHIP REPAID. N SUFFICIENT TO PAY FOR THE ABOVE ORDER.
e
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
't
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. Y CLh I Qf Pcllce THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL No. A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
C �t
ON ACCOUNT OF APPROPRIATION FOR
Board Members
POP, or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor Vehicle highway fund
VOUCHER NO. WARRANT NO.
Tom O'Brien CDJR North ALLOWED 20
IN SUM OF
4630 E. 96th Street
Indianapolis, IN 46240
$10,663.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# i Dept. INVOICE NO. ACCT #rr]TLE AMOUNT Board Members
25937
Encumbered 44- 650.01 $10,280.00 1 hereby certify that the attached invoice(s), or
Encumbered bill(s) is (are) true and correct and that the
25937 471338 44- 650.01 $383.80
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, February 23, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
02/15/12 new vehicle $10,280.00
02/20/12 471338 new vehicle keys $383.80
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