HomeMy WebLinkAbout177766 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
o CARMEL, INDIANA 46032 PO BOX 2856 CHECK AMOUNT: $38.40
KOKOMO IN 46904 -2856 CHECK NUMBER: 177766
bi ron io•
CHECK DATE: 9/29/2009
DEPAR ACCOUNT PO NUMBER INVOIC NUMBE AMOU DES
1207 4239040 38.40 FOOD BEVERAGES
�MID�MMERICA INVOICE
B „VEIMGE BROOKSHIRE FIRST MORTGAGE!
dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856 K 1Y 55 "1_ t U 11 5 lU
765- 459 -3117
800 382 -0675
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
10/01/09 396271 Dustin Smith 13 800 13
a. BASE SEPTEMBER 28,2009A
PROMO #1009A
PUMP %40/$33 REFUNDABLE
209 6 Bud Lt 24 Lse Can 16.40 98.40
Cases 6
TOTAL SALE 98
10303 J EMPTY AB 1/6 30.00® T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 3��� A
10310 EMPTY IMPORT 112 30.00 N
9230. PUMP DEPOSIT 33.00 K
9270 IMPORT PUMP DEPOSIT 33.00 98.40
T OTAL RETURNS
noo CREDITS
Cash El EFT ❑Escrow Check Number
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Dnver %r Received By
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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
&Q2 1 ,42 e 1011 Purchase Order No.
?,6 _d sL Terms
1<
C 11 L 1 7^,jJ q Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9 9 ba 7 i2 v VL
Total a
I 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
s VOUCHER NO. WARRANT NO.
ALLOWED 20
A//b IN SUM OF
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
20��
r 4 s�, at
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund