173450 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CHECK AMOUNT: $416.30
CARMEL, INDIANA 46032 Po BOX 2856
KOKOMO IN 46904 -2856 CHECK NUMBER: 173450
CHECK DATE: 6/10/2009
DEPARTM ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DES CRIPTI ON
1207 4239'040 416.30 FOOD BEVERAGES
MIWAMERICA I NVOICE
11MRACE BROOKSHIRE FIRST MORTGAGE.
IN dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY.
2755 Commerce Dr, CARMEL IN 46032'
P.O. Box 2856
Kokomo, IN 46904 2856 RR2903542 EXP 07/13/09
765 459 -3117
800 382 -0675
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
06/12/09 385993 David Hulsey 13 B00 13
P ICE DEPOSI AMOUNT
BASE FEB 2, 2009A
PROMO #609A
PUMP $40/$33 REFUNDABLE
209 14' Bud. Lt 24 Lse Can 15.95 223.3
225 2 Bud Lt 1/4 BBL 41.50 30.00 143.00
760 2 Goose Wheat 312 1/6 BBL 55.00 30.00 170.00
Cases 14 1/4 Barrels 4
TOTAL SALE 536.30
10303 3 EMPTY AB 1/6 30.00 (O, T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00
10310 EMPTY IMPORT 1/2, 30.00
9230 PUMP DEPOSIT 33.00 K
9270 IMPORT. PUMP DEPOSIT 33.00 536.30.
CREDITS IO
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El Cash El EFT ❑Escrow /1 Check Number
Driver Received By
Prescribed by State Board of Accounts City 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
�&,se-io q /2EI)4 Pad Purchase Order No.
o2 2 S s 6Ovncn 1612
o 4 Q ak-, Terms
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<6/KQMO JC4J Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9 39S &E-E-2 �a
Total q /(O 30
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
ON ACCOUNT OF APPROPRIATION FOR
C,f o
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�0 38 S" 993 0 o �16J6 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
Sig ii A /A0-r—
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund