177383 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 361935 Page 1 of 1
0 f, ONE CIVIC SQUARE SAHM'S RESTAURANT BAR CHECK AMOUNT: $1,532.97
I�. CARMEL, INDIANA 46032 11590 ALLISONVILLE ROAD
FISHERS IN 46038 CHECK NUMBER: 177383
CHECK DATE: 9/15/2009
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DE SCRIPTION
1207 4239040 36556 1,532.97 FOOD BEVERAGES
Inv ®ice
Sahm's Restaurant Bar Invoice Number:
11590 Allisonville Road 36556
Fishers, IN 46038
Invoice Date:
Aug 28, 2009
Voice: 317- 842 -1517
Fax: 317 -57'7 -8216 1
1
Duplicate
Sold To: Ship to:
Brookshire
12120 Brookshire Parkway
Carmel, IN 46038
Customer ID Customer PO Payment Tenns
Y BROOK,SHIRE Net 15 Days
Sales Rep ID Shipping Method Ship Date Due Date
Airborne 9/12/09
Quantity Item Description. Unit Price Extension
ATTN. PAM LISTER
100.001144B Lunch Group A B Two Entree 12.95 1,295.00
(31 -100 ppl)
100.001170 Dessert tray, one item 1.9 195.00
1.0 9002 Delivery, Set Up Pick Up 40.00 40.00
1.0 9003 ileage Surcharge 2.97 2.97
Subtotal 1,532.97
Sales Tax
Total Invoice Amount 1,532.97
Check/Credit Memo No: Payment /Credit Applied
TOTAL 1,532.97
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 204 (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
x2 Z) Purchase Order No.
96) A� n��Ji`l�� Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 U 3a
Total
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 NO.
ALLOWED 20
IN SUM OF
4
ON ACCOUNT OF APPROPRIATION FOR
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
2062
f�
ignature
6t fn itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund