177072 08/15/2009 CITY OF CARMEL INDIANA VENDOR: T359703 Page 1 of 1
ONE CIVIC SQUARE KELLY M MIELKE CHECK AMOUNT: $11.97
CARMEL, INDIANA 46032 131 1STAVE SE
CARMEL IN 46032 CHECK NUMBER: 177072
CHECK DATE: 9115/2009
DEPARTM ACCOU PO NUMBE NUMB MOUNT DESCRIPTION
902 4239099 n R 11.97 OTHER MISCELLANOUS
ROBERTS' DISTRIBUTORS, LP
12225 N. MERIDIAN ST.
CARMEL' IN 48032
317-818-8800
TiCk8t# 5-1142387 User: 55
O[iQ 0[d 5-1142387
09/02/2008 3:12 pm S14t1OD; 503
Item Uty Price Total
Description
G{O-00016 1 11.97 11.87
GTO-AA\9OO
Subtotal 11.87
Tax 0.84
Total 12.81
/pnner�
l2.81
A 5-1142387
Clue
-It purchased:
No H8[ddndlsi irntd beyond l
days from du1* ^i All
Ne[c 0u�� condition,
have Ong1nxl p*d i`.� ,id be returned
with blank Nu/cu|Jy Restocking
fee may applY.
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
i �/l f IBC Purchase Order No.
1 31 I ('S4 4v e S E Terms
CA Of 2 D.3 Z Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Q 0902,01 ko cCA rn er g re Git
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.
-7o* r I ALLOWED 20
IN SUM OF
13 I+- Av e S
Ca nm -TW q(a03
ON ACCOUNT OF APPROPRIATION FOR
Z12 5 9 q
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
got O�pyOR y23So4� 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
200'
&66ture
Director of Operations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund