177324 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1
ONE CIVIC SQUARE MONARCH BEVERAGE CO INC
CHECK AMOUNT: $300.30
CARMEL, INDIANA 46032 3737 WALDEMERE AVE
INDIANAPOLIS IN 46241
CHECK NUMBER: 177324
CHECK DATE: 9/15/2009
DEPARTMENT A CCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 300.30 FOOD BEVERAGES
11 Al
em. NARCH BEVERAGE CO. I NC.
PERMIT #W4908938- I NP 1983
3737 WALDEMERE ROAD
INDIANAPOLIS, IN 46241-0000
(317)612-1310
Account 89924 License R2903542 Time: 11:56
AZ GOLF MANAGEMENT CORP, Invoice#: 0'56954 PO#
BROOKSHIRE GOLF CLUB Load 4040 Date. 09-17-2009
12120 BROOKSHIRE PKWY Terms B.COD7W.CHARGE
CARMEL, IN 46032 -0000 Driver VB PHILLIPPO,C
(317)846 -7431 Salesman: 16 T. WEBSTER 16
ITEM# CITY DESCRIPTION U.P.C. v PRICE DISC DEP AMOUNT
20610 6 COORS LIGHT 07199031600 16.05 0.00 0.00 96.30
24 LSE CAN
30975 4 HEINEKEN 07289000020 27.00 0.00 0.00 108.00
12 CAN
10110 6 LITE 03410057306 16.00 0.00 0.00 96.00
24 LSE CAN
Cases: 16 Beer$: 300.30 Content$: 300.30
BUS: 0 Wine$: 0.00 Deposit$: 0.00
Kegs: 0 Soda$: 0.00 Discount$: 0.00
Misc: 0 Misc$: 0.00
Gals: 36.0
Total Sales 300.30
Total Credits 0.00
Total Tax 0.00
INVOICE TOTAL 300.30
PAYMENT
INVOICE# PAYMENT TYPE AMOUNT
0156954 Cash and Check 300.30
Total Charge 0.00
Total Cash and Check 300.30
Total 300.30
PAYMENT TYPE AMOUNT
Cash 0.00
Check# 7 300.30
Total Checks 300.30
Total Collected 300.30
1-0: 015054 300.30
Customer's Signature Driver's Signature
"Yuur signature is acceptance that allthe product listed above was Feceived
and delivered in good condition"
Di ivers cannot pickup product unless proper Pickup furm has been completed.**
Not Responsible foF shortage uF breakage after merchandise is delivered and
accepted
VALID
7 c.' 1 e'_!"yStF 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
oz Purchase Order No.
.3`l97 4,� Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
1 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
�'U eZ IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
16e�,36 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 0
nature
itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund