179918 11/30/2009 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC CHECK AMOUNT: $212.50
CARME-", INDIANA 46032 PO BOX 2856
KOKOMO IN 46904 -2856 CHECK NUMBER: 179918
CHECK DATE: 11/30/2009
DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION
1207 4239040 212.50 FOOD BEVERAGES
MI,MERICA INVOICE
B BROOKSH I RE FIRST MORTGAGE
d ba BROOKSH I f�E GOLF CLUB''
1NC
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, 904
765 459 3117 9 3117 RR2903542 EXP. 07/13/10
765
800 382 0675 Thursday Delivery
Fax: 765 457 7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
12/03/09 401745 Dustin Smith 13 600 13
C PRODUCTI QUANTITY DESCRIPTION PRICE DEPOSIT AMOUNT
BASE November 2, 2009A
PROMO #1209A
PUMP $40/$33 REFUNDABLE
225 1 Bud Lt 1/4 BBL 42.50 30.00 72.50
r r s 4t�
L >r P
E 1 6 s 1
0
1/4 Barrels 1
°D TOTAL SALE 72.50
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 J H
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00 K
9270. ..IMPORT.PUMP DEPOSIT 33.00 ,s� 72.50
"Awe ic y
O CREDITS r 2 1
Cash EFT Escrow Check Number U
Driver J� a Received By
a
ERICA INVOICE
B BROOKSHIRE FIRST MORTGAGE
INC■ dba BROIOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY,
27556 mmerce Dr. CARMEL IN 46032
P.O. Box 2856
K okomo IN 46904-2856
765 459 5-459 3117 RR2903542 EXP. 07/13/10
800- 382 -0675 T h u r s d.a y Delivery
Fax: 765 -457 -7967
BEER W3409212
INVOICE DATE INVOICE, NUMBER SALESMAN NUMBER- CUSTOMER NUMBER ROUTE
12/04/09 402199 Dustin Smith i3 EIC 13
DEPOSIT
DESCRIPTION
BASE`November 2, 2009A
PROMO #1209A
PUMP $40/$33 REFUNDABLE-
760 2 Goose Wheat 312 1/6 BBL` 55.00 30.00 170.00
ZD
i
1/4 Barrels 2
L�
TOTAL SALE 170.
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
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 33.00 170.00
y
u
CREDITS
a.
Cash EFT Escrow Check Number 4 U
r
i
Driver Received By
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
t
Purchase Order No.
�d,Y Terms
A Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02�o G/7 2
1 q 1 a 9
Total
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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
/_26
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1,2 _.50 bill(s) is (are) true and correct and that the
,20 l/oa 9 9 34&, �o, Go materials or services itemized thereon for
which charge is made were ordered and
received except
et :7 20
Signature
Titl
Cost distribution ledger classification if
claim paid motor vehicle highway fund