177374 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 264001 Page 1 of 1
o ONE CIVIC SQUARE RED WING SHOE STORES INC
CARMEL, INDIANA 46032 CHECK AMOUNT: $396.47
6653E 82ND ST
o� iNDPLS IN 46250 CHECK NUMBER: 177374
CHECK DATE: 9/15/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356003 51000002850 396.47 SAFETY ACCESSORIES
r
Original Invoice
BILL TO REMIT TO
ATTN: BONNIE CALLAHAN Red Wing Shoe Store
CARMEL CITY STREET DEPT Castleton Village
3400 W 131 ST ST 6653 Fast 82nd St.
WESTFIELD, IN 46074 Indianapolis, IN 4625011577
(317) 577 -0760
Invoice Number Invoice Date Terms Description
510000002850 09/05/2009 Net 30
Ticket Date Purchased By Other Information Item Amount
00051.025063 07128/2009 LOVEALL, DAVID 02225D 090 157.49
Total $157.49
Net Total $157.49
00051025064 07/28/2009 KILLEN, TERRY 02240H 095 143.99
Total $143.99
Net Total $143.99
00051025234 08/1812009 MONTGOMERY, CRYSTAL 05108M 095 94.99
Total $94.99
Net Total 594.99
Total Merch $396.47
Customer Tax $0.00
Maj. Acct. Tax $0.00
Message: Total Charges $396.47
Customer Payment $0.00
Maj. Acct. Payment $0.00
Total Due $396.47
Date Due 10/05/2009
1
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))
09/05/09 510000002850 $396.47
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 N
ALLOWED 20
Red Wing Shoe Store
IN SUM OF
6653 E. 82nd Street
Indianapolis, IN 46250 -4577
$396.47
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 510000002850 43- 560.03 $396.47 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
Thursda r y, S ber 10, 2009
i
!fl 4
Street Commi si ner
Title "'Yr
Cost distribution ledger classification if
claim paid motor vehicle highway fund