178785 10/28/2009 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: $55.50
INDIANAPOLIS IN 46241
�o CHECK NUMBER: 178785
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 55.50 FOOD BEVERAGES
`MONARCH BEVERAGE CO. INC.
PERMIT #W4908938-INP1983
9347 E PENDLETON PIKE
INDIANAPOLIS, IN 46236-0000
(317)612-1310
Account 89924 License R2903542 Time: 10:21
AZ GOLF MANAGEMENT CORP. Invoice#: 0202703 PO#
BROOKSHIRE GOLF CLUB Load 4040 Date: 10-29 -2009
12120 BROOKSHIRE PKWY Terms B.CODlW.CHARGE
CARMEL, IN 46032 0000 Driver W1( WAGNER,S
(317)846.7431 Salesman: 16 T. WEBSTER 16
ITEM# QTY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT
24569 1 SAM ADAMS KEG 00000000000 55.50 0.00 30.00 85.50
LAGER 116 BBL
31164 -1 MISC DEP. 01003116400 0.00 0.00 30.00 -30.00
$30 EMPTY KEG
Cases: 0 Beer$: 85.50 Content$: 55.50
Btls: 0 Wine$: 0.00 Deposit$: 0.00
Kegs: 1 Soda$: 0.00 Discount$: 0.00
Misc: 0 Misc$: 0.00
Gals: 5.1
Total Sales 85.50
Total Credits 30.00
Total Tax 0.00
INVOICE TOTAL 55.50
PAYMENT
INVOICE# PAYMENT TYPE AMOUNT
-J 0202703 Cash/Check
Total Cash /Check 55.50
PAYMENT TYPE AMOUNT
Check# 178785 55.50
Inv0; 0802703 55.50
V
Customer's Signature Driver's Signature
"Your signature is acceptance that all 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
ascribed 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
_Mwax &G. Purchase Order No.
,3 '7,; 7 E/ZC ,/TUGl. Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
373 6111P n�
mss•
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
90 S"S S� 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
7 1 5 20 O
�3� �0 L4,e
S ignature
Ti le
Cost distribution ledger classification if
claim paid motor vehicle highway fund