HomeMy WebLinkAbout173119 05/28/2009 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
.f` ONE CIVIC SQUARE MID AMERICA BEVERAGE INC CHECK AMOUNT: $285.95
CARMEL, INDIANA 46032 PO Box 2856
KOKOMO IN 46904 -2856 CHECK NUMBER: 173119
CHECK DATE: 5/28/2009
DE PARTMEN T AC COUNT PO NUMB INVOIC NUMBER AMOUNT DESCR
`1207 4239040 285.95 FOOD BEVERAGES
MIWAMERICA INVOICE
R A G E BROOKSHIRE FIRST MORTGAGE
®���j' w d ba BROOKSHIRE GOLF CLUB
EEJJ!!!! 12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856
765 459 -3117 RR2903542
800 382 -0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
05/28/09 384923 David Hulsey 13 800 13
ERMIMIMFIVINAM
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o' o o- o o o o 11V i I A l �PW R4
III I I '11. Ili II 1 I I I� 1
II III III I II
I r. III I �IPI 111 .1 I ;VIII' II iitt II 1,4o1V II .111 'l I II 1
1 C j, II III I) 11,'n: PAYABLE AT I I I 1 711 '859
I I f li I II I
TY OF CARMEL INDIANA FIFTH THIRD BANK 1' 73 1i'9
0 I�\ ONE CIVICr'SQUARE INDIANAPOLIS INDIANAIn "'•.1 749 I lil 1 1 I II d
1 DATE. 512812009
I Y J
CARMEL INDIANA "46032.. GENERAL ACCOUNT
AMOUNT
I
$286.9.5
CTS CTS
I: 1 I :TWO FICHT FIVE �IIi.II„
THIS WARRANT IS VOID TWO (2) YEARS AFTER
nd�l L! I I
DECEMBER 31 OF THE YEAR OF ISSUE
To MID. AMERICA BEVERAGE INC
The PO'BOX 2H 6 CLERK- TREASURER
Order 9 56
KOKOMO;,.IN 46, ,04 28,
Of;
li■ 17 3 L L 9 n■ 0 7 4 9 0 B �5 9 4 i;. 9 9 "q �3 4- 2�� li:
0
285-95
(;uKKE
55-0 y 1
MiD AMERICA OWES 00
,es 16 YOU OWE
(V
TOTAL SALE 6
10303 EMPTY AB 1/6 30.00 t S
10304 EMPTY AB 1/2 30.00 H U
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00 260.95
r O CREDITS
Cash EFT Escrow C heck Number U A D
Y
Driver Received B
MWAMERICA I NVOICE
RA E BROOKSH,IRE .FIRST MORTGAGE
1�� d.ba BROOKSHIRE GOLF, CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
<r P.O. Box 2856
Kokomo, IN 46904 -2856 RR2903542 EXP
765 459 -3117
800- 382 -0675
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
05/28/09 384923 David Hulsey 13 800 1.3
QUANTITY PRICE DEPOSIT AMOUNT
PR6-666Y DESCRIPTION
BASE FEB 2, 2009A
PROMO #0509A
PUMP $40/$33 REFUNDABLE
209 11'' Bud Lt 24/12 oz Can 15.95 175.45
908 5' Mich Ultra 2/12 Can 17.10 85.50
Cases 16
TOTAL SALE 260.95
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 .30.00 H
10405 EMPTY AB 1/4 30.000, A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00 K
9270 IMPORT PUMP DEPOSIT. 33.00. 260.95
x 4a D
CREDITS
Cash EFT Escrow Check Number U .ea
Driver Received By //k, �j
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 j�
�JfJ Purchase Order No.
SS" e6 in m 2 •0 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
X8'0 3 (f'//9a3
Total 1� 9s
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
/11f VJ H
n IN SUM OF
o2,7.S�S Cprn m �,�c_E
-n n� "s
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1/1 9a 3 9D Vy ,.30, 9S� 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
clf� g r
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund