206886 03/07/2012 CITY OF CARMEL, INDIANA VENDOR: 365015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC
CARMEL, INDIANA 46032 PO BOX 6293 CHECK AMOUNT: $677.24
CAROL STREAM IL 60197 -6293 CHECK NUMBER: 206886
CHECK DATE: 3!7!2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231400 28725837 677.24 0496 -00- 138012 -0
I nvoi oe Statement
IRS INVOICE NUMBER: 28725837
ACCOUNT NAME: City of Carmel Fire
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496 00-138012 -0 3400.00 29 FEB- 29-2012 MAR 26-2012 1 677.24
DATE ACTIVITY DESCRIPTION CHARGESYDEBIT'S' PAYMENTS /CREDITS
FEB -24 -2012 PAYMENT THANK YOU 729.35
FEB -29= 2012,: FUEL PURCHASES 677,.24
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE 9
RIGHT PORTION OF THE REMITTANCE STUB.
L
D
MAR 0 5 2012
By
PURCHASES, RETURNS AND PAYMENTSMADE JUST PRIORTO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/SIATEMENT.
PREVVOUS BALANCE PAYMENTS (,)PURCHASES )DEBITS CREDITS (,)LATE FE )NEW BALANCE
729.35 729.35 677.24 0.00 0.00 0.00 677.24
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 late
applying a mo thIX rate of RATE of fee for this p eriod which is
2.08 24.99 0.00
SEE REVERSE SI DE FOR IM PORTANT I NFORMATION AND TERMS.
TQ €N %aE ER-OPEF3 CBEDIT-TEAR A_T PERFORATIQN ACID INCLVQE_BQTTQM_In IQf WIT YQt�IR PAYMENT,
ACCOUNT: NAME, City of Carmel Fire
ACCOUNT'NUMBER 04WOO- 138012 -0 Circe K Fl eet
INVOICE NUMBER 28725837
BILL CLOSING DATE'- FEB- 29.2012 FAX CHANGE OF ADDRESS REQUEST TO 1- 800 3960809"
Makecheck payable to: WRIGHT EXPRESS FSC.
AMOUNT. DUE 677.24 Use endosed envelope or send to:
'AMOUNT' ENCLOSED
t
PAYMENT'DUE;DATE MAR -26 -2012
PAYMENTS RECEIVED AFTER THIS DATE SUBJECTTO LATE FEES A
I IIII IIIII IIIII IIIII II III IIIII III II IIIII IIIIIIIIEIII
WRIGHT EXPRESS FSC
P.O. BOX 6293
CAROL STREAM IL 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 28725837 Fuel for Fire Department $677.24
Total $677.24
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. 03/05/12 WARRANT NO.
Wright Express FSC ALLOWED 20
IN SUM OF
PO Box 6293
Carol Stream, IL 60197
$677.2
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
Board Members
PO# or D PT. INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1 120 5837 314 i77,24
materials or services itemized thereon for
which charge is made were ordered and
received except
X 20
Signature
Title
Cost distribution ledger classification it
claim paid motor vehicle highway fund