176421 08/19/2009 CITY OF CARMEL., INDIANA VENDOR: 361935 Page 1 of 1
0 ONE CIVIC SQUARE SAHM'S RESTAURANT BAR
CARMEL, INDIANA 46032 11590 ALLISONVILLE ROAD CHECK AMOUNT: $460.87
FISHERS IN 45038
CHECK NUMBER: 176421
CHECK DATE: 8/19120D9
DEPARTMENT ACC OUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 36433 460.87 FOOD BEVERAGES
Invoice
Sahm's Restaurant Bar Invoice Number:
11590 Allisonville Road
Fishers, IN 46038 36433
Invoice Date:
Aug 1, 2009
Voice: 317 -842 -1577 Page:
e
Fax: 317 577 -8216
1
Duplicate
Sold To: Ship to:
Brookshire
12120 Brookshire Parkway
Carmel, IN 46038
Customer ID Customer PO Payment Tei7ns
8ROOKSHIRE Net 15 Days
Sales Rep ID Shipping Method Ship Date Due Date
Airborne 8/16/09
Quantity Item Description Unit Price Extension
ATTN. PAM LISTER
42.0011438 Lunch Group A One Entree (31 -100 9.95 417.90
pl)
1.0 9002 Delivery, Set Up Pick Up 40.00 40.00
1.0 9003 ileage Surcharge 2.97 2.97
Subtotal 460.87
Sales Tax
Total Invoice Amount 460.87
Check/Credit Memo No: Payment /Credit Applied
TOTAL 460.87
r
Prescribed ¢y State Aid 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
4- Purchase Order No.
z l ;a Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
o IN SUM OF
Poo
Ls 3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT I hereby certify that the attached invoice(s), or
�1_ 3 yv p, 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
l 20 Q
v—,
nature
itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund