206794 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 00352664 Page 1 of 1
�r ONE CIVIC SQUARE RELYCO SALES INC CHECK AMOUNT: $1,259.81
CARMEL, INDIANA 46032 121 BROADWAY
DOVER NH 03820 CHECK NUMBER: 206794
CHECK DATE: 2/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4230000 SIN013088 1,259.81 OFFICIAL FORMS
121 Broadway Dover NH 03820 INVOICE
T (800) 777 -7359 (603) 742 -0999 Invoice Number: SIN013088
F (603) 742 -9993 Invoice Date: 02/21/2012
E info @relyco.com Due Date: 03/21/2012
www.relyco.com Purchase Order C.SHEEKS
Payment Terms: 1 10 Net 30
Bill To: 5081 Ship To: 5081
CITY OF CARMEL CLERK TREASURER CITY OF CARMEL CLERK TREASURER
One Civic Square Cindy Sheeks
Carmel, IN 46032 -2584 One Civic Square
USA Carmel, IN 46032 -2584
USA
Item „Number Description QTY _UOM �4n �UOM 'ShipsVia� Unit
rice
Ext Price
Ordered'” Shipped x
IT
04517 BLUE LASER CHECK BOTTOM 10.00 CS 10.00 CS UPS CWT $114.00 $1,140.00
Sub Total $1,140.00
Shipping $119.81
Handling
Sales Tax $0.00
Invoice Total $1,259.81
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1 1
BUS /NESS PRINTING SOLUTIONS
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
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
ON ACCOUNT OF APPROPRIATION FOR
i��7 �d�
Board Members
PO# 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
�1
Signature f if
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund