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175057 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 358794 Page 1 of 1 ONE CIVIC SQUARE OLD TOWN TAVERN CARMEL, INDIANA 46032 29 W MAIN sr CHECK AMOUNT: $50.00 CARMEL IN 46032 CHECK NUMBER: 175057 CHECK DATE: 7122/2009 DEPARTMENT ACCOUNT PO NUMBER INVOIC NU AMO DESCRIPTION 902 4359003 50.00 PERMIT REFUND J� �D3 0 i i lu I. S �Sumc Zo, 2L r CL�L w� SI- 0 �L� �N (O\ L\c i Amount Paid 50.00 4.,� o� Alcohol and Tobacco Con :mission A 30213'est Washington Streel Room' El 14 Date PaUd X611 0/20U9 MA it Indianapolis, Indiana 46204 v 1 1'' 4 .Reeerpt Numb ,,200919463002 (317J 232 -2430 Ipti aw 4 Approved By State 8oard�of Accounts 1999 MR A0 ow "r TEMPORARY BEER AND WINE PERMI, a ..a x i n r Fe I u r J v ltd F 1�( x t /5t Temporary Number Permit Issue Date Temporary Bartendersv� Event Begin Date r t fa N jEaent End Date ill V k 11 t TM0029770 x,61,1012009 �0 ©'6Y2012'0`09 r Sr;�0'612'O i 1200�9�� Permit Locatwn x i Name Of Permittee OLD TOWN TAVERN 29W MAIN ST 29 W. MAIN ST. CARMEL IN 46032 CARMEL IN 46032z ,t Temporary Bartenders: Oft w.. r t 8 k rt ii rJ 4 e 'a` JET i rr i/ t fist k KI I e r1 i ae �iY r �ID r Chairman Alcohol and Tobacco Commission STATE FORM 49122 ;e �a 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 To P? �y Purchase Order No. 9 �l�s, �Sf Terms Date Due Invoice Invoice Description Amount Date y Number (or note attached invoice(s) or bill(s)) j� L J et J Total 5` I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in a "or ance with IC 5- 11- 10 -1.6. 20 G Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 0 To, e" IN SUM OF ON ACCOUNT OF APPROPRIATION FOR �'2�y3 S9�a 3 Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or g�2 7 E a9 5959Ga3 Sacs 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 Q G7 Sign re itle Cost distribution ledger classification if claim paid motor vehicle highway fund