179331 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1
ONE CIVIC SQUARE MONARCH BEVERAGE CO INC
CARMEL, INDIANA 46032 3737 WALDEMERE AVE CHECK AMOUNT: $96.50
INDIANAPOLIS IN 46241
CHECK NUMBER: 179331
CHECK DATE: 11/11/2009
4
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 96.50 FOOD BEVERAGES
I11V
PERMIT #W4908938- INP1983
9347 E PENDLETON PIKE
INDIANAPOLIS, IN 46236 -0000
(317)612-1310
Account 89924 License R2903542 Time: 12:11
AZ GOLF MANAGEMENT CORP. Invoiced: 0218165 PO#
BROOKSHIRE GOLF CLUB Load 4040 Date: 11 -2009
12120 BROOKSHIRE PKWY Terms C.O.D. ONLY
CARMEL, IN 46032 -0000 Driver UB PHILLIPPO,C
(317)846 -7431 Salesman: 16 T. WEBSTER 16
ITEM# QTY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT
10180 1 LITE KEG 03410057154 41.00 0.00 30.00 71.00
LITE 114 BBL
24569 1 SAM ADAMS KEG 00000000000 55.50 0.00 30.00 85.50
LAGER 116 BBL
31164 -2 MISC DEP. 01003116400 0.00 0.00 30.00 -60.00
$30 EMPTY KEG
Cases 0 Beer$: 156 50 Content$ 96.50
Btls: 0 Wine$: 0.00 Deposit$: 0.00
Kegs: 2 Soda$: 0.00 Discount$: 0.00
Misc: 0 Misc$: 0.00
Gals: 12.9
Total Sales 156.50
Total Credits -60.00
Total Tax 0.00
INVOICE TOTAL 96.50
PAYMENT
INVOICE# PAYMENT TYPE AMOUNT
0218165 Cash/Check 96.50
Total Cash/Check 96.50
PAYMENT TYPE AMOUNT
Check# 6 96.50
Inv 0218165 96.50
Customer's Signature Driver's Signature
"Your signature is acceptance that a I I the product listed above was received
and delivered in good condition"
Drivers cannot pickup product unless proper pickup form has been completed.`"
Not Responsible for shortage or breakage after merchandise is delivered and
accepted
VALID
Pi 9 cribed 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
W-0 tj )q CEO— b Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total �G
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.
t:
ALLOWED 20
4 72 IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
1,�26 '7
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
I�ID j 12 20 O�
c
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund