206885 03/07/2012 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC CHECK AMOUNT: $31.46
,a CARMEL, INDIANA 46032 PO BOX 6293
.roN Lo CAROL STREAM IL 60197 -6293 CHECK NUMBER: 206885
CHECK DATE: 317/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 28724524 31.46 0496 -00- 138002 -1
I nvoi ce Statement
21a INVOICE NUMBER: 28724524
ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
049Cr00138002 -1 550.00 29 1 FEB- 29-2012 MAR 262012 31.46
DATE ACTIVETY DESCRIPTION CHARGES /DEBITS PAYMENTS /CREDITS
;FE6:17 2012 PAYMENT THANK YOU 180.53
FEB -24- 2012.' PAYMENT THANK YOU 270.35
FEB -29- 2012 FUEL PURCHASES 211.99
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
t
MAR 0 5 2012
BY
PURCHASES, RETURNS AND PAYMENTS MADE JUST PRIOR TO BI LLING DATE MAY NOT APPEAR UNTI L THE NEXT INVOICE/STATEM ENT.
PREVIOUS BALANCE PAYMENTS (,)PURCHASES (,)DEBITS CREDITS (,)LATE FE )NEW BALANCE
270.35 450.88 211.99 0.00 0.00 0.00 31.46
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to laic
applying a monthly rate of RATE of fee for this period which is
2.08 24.99 0.00
SEE REVERSE SI DE FOR IMPORTANT I NFORMATI ON AND TERMS.
TQ EfvS�UR_E_FRQPER Q�EDIT�T =AR A T_FERFQRA �I9i� APIG I fvQL�iDE 80TTt�id_FvFFTI O WIThYQ�IR PAYMENT.
ACCOUNT "NAME City of Carmel Admin
�ACCOUNT•NUMBER. 0496-00- 138002 -1 Circle K Fleet
4NV010E NUMBER.: 28724524
BILL CLOSING DATEr FEB- 29-2012 FAX CHANGE OF ADDRESS REQUEST TO 1- 800 395.0809.
M ake c heck payable to: WRIGHT EXPRESS FSC.
AMOUNT DUE 31.46 Use enclosed envelope or SArd to:
`AMOUNT ENCLOSED 31
'PAYMENT DUE DATE MAR- 26.2012
PAYMENTS RECEIVED AFTER THIS DATE SUBJECT TO LATE FEES w
ItllttllsttttJllJt ,ItttJJl�t�tltlltltt�JlJtttl!
WRIGHT EXPRESS FSC
P.O. BOX 6293
CAROL STREAM I L 60197 -6293
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
Wright Express FSC Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03/05/12 28724524 Fuel for Admin $31.46
Total $31.46
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 N0 031115112 WARRANT NO.
ALLOWED 20
Wright Express F
IN SUM OF
PO Box 6293
Carol Stream, IL 60197
$31.46
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
Board Members
D INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
28724524 314 31.46 materials or services itemized thereon for
which charge is made were ordered and
received except
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund