168221 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 360940 Page 1 of 1
f ONE CIVIC SQUARE TRIPLE S TIRE CO INC CHECK AMOUNT: $200.74
is CARMEL, INDIANA 46032 836 S 22ND ST
*,ro„ ELWOOD IN 46036 CHECK NUMBER: 168221
CHECK DATE: 1/2112009
DEPARTMENT ACCOUNT P O NUMB INVOICE NU MBER AMOU DESCRIPTION
2201 4232000 4689 200.74 TIRES TUBES
ei
C
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Printed: 116/20099:36:52 AM INVOICE Sales Receipt #4689
Store: IN 12/29/2008
Cashier: Chris
Page 1
Copy
TRIPLE S TIRE INDIANAPOLIS
836 S. 22ND ST.
ELWOOD, IN 46036
(765) 552 -5765
FAX: (765) 552 -5761
REMIT PAYMENT ABOVE
Bill To: CITY OF CARMEL
CITY OF CARMEL,
3400 WEST 131 ST
WEST FIELD, IN 46074
Description 1 D escript ion 2 Ply Size Qty Price Ext Pricera)
25" O -RING 1 $25.74 $25 -74 -T—
Labor retail Mt /DisMt,Repair,On /Off, Inspect 1 $50.00 $50.00
SERVICE CALL TRAVEL AND HOURLY FEES 1 $125.00 $125.00
Subtotal: $200.74
Exempt 0 Tax: +$0.00
Ship 12129/2008 510502 Shipping:
RECEIPT TOTAL: $200.74
Account: $200.74
Signature
Previous Account Balance: $0.00
EQ# JD624J
LR
HRS: 1298
SWO# 510502
PLEASE_ PAY FROM THIS INVOICE SALES RECEIPT. TERMS NET 30
WITH BILLING QUESTIONS CALL 765 -552 -5765 THANK YOU
1 1111 VIII VIII 11111 11111 111 1111
4689
Prescribed by State Board of Accounts Cly 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.
r,
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/29/08 4689 $200.74
l 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
V NO_ WARRANT NO.
ALLOWED 20
Triple S. of Indy, Inc.
IN SUM OF
836 S. 22nd St.
Elwood, IN 46036
$200.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT
Board Members
2201 4689 42 320.00 $200.74 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
r,
/Saturd y, Jan 17, 2009
Sft"mm ission
c�r�r�r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund