176006 08/12/2009 CITY OF CARMEL, INDIANA VENDOR: 359290 Page 1 of 1
ONE CIVIC SQUARE MONARCH BEVERAGE CO INC CHECK AMOUNT: $506.40
o CARMEL, INDIANA 46032 3737 WALDEMERE AVE
a, o� INDIANAPOLIS IN 46241 CHECK NUMBER: 176006
CHECK DATE: 8/12/2009
DEPARTME ACCOUNT PO NUMBER INVOICE NU MBER AM OUNT DESC
1207 4239040 506.40 FOOD BEVERAGES
•••v.. uc r cnMViC VV I NV. .nvi��nvn uc v CnI•►taC VV I N%;
5 PERMIT #W4908938-INP1983 PERMIT #W4908938-INP1983
3737 WALOEMERE ROAD 3737 WALDEMERE ROAD
INDIANAPOLIS, IN 46241 -0000
INDIANAPOLIS, IN 46241-0000
(317)612-1310 (317)612-1310
Account B9924 License R2903542 Time: 12:33 Account B9924 License R2903542 Time: 12:33
AZ GOLF MANAGEMENT CORP. Invoice 0946397 PO# AZ GOLF MANAGEMENT CORP. Invoice#: 0946398 PO#
BROOKSHIRE GOLF CLUB Load 4040 Date: 08- 13-2009 BROOKSHIRE GOLF CLUB Load 4040 Date: 08- 13-2009
12120 BROOKSHIRE PKWY Terms B.COD /W.CHARGE 12120 BROOKSHIRE PKWY Terms B.COD /W.CHARGE
CARMEL, IN 46032-0000 Driver VB PHILLIPPO,C CARMEL, IN 46032 -0000 Driver VB PHILLIPPO,C
(317)846 -7431 Salesman: 16 T. WEBSTER 16 (317)846-7431 Salesman: 16 T. WEBSTER 16
ITEM# QTY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT ITEM# QTY DESCRIPTION U.P.C. PRICE DISC DEP AMOUNT
20610 18 COORS LT 07199031600 16.05 0.00 0.00 288.90 24569 1 SAM ADAMS KEG 00000000000 55.50 0.00 30.00 85.50
24 LSE CAN LAGER 116 BBL
10110 12 LITE 03410057305 16.00 0.00 0.00 192.00 31164 -1 MISC DEP. 01003116400 0.00 0.00 30.00 -30.00
24 LSE CAN $30 EMPTY KEG
:ases: 30 Beer$: 480.90 Content$: 480.90 Cases: 0 Beer$: 85.50 Content$: 55.50
3tls: 0 Wine$: 0.00 Deposit$: 0.00 Btls: 0 Wine$: 0.00 Deposit$: 0.00
(egs: 0 Soda$: 0.00 Discount$: 0.00 Kegs: 1 Soda$: 0.00 Discount$: 0.00
list: 0 Misc$: 0.00 Misc: 0 1) Misc$: 0.00
ials: 67.5 Gals: 5.1
Total Sales 480.90 Total Sales 85.50
Total Credits 0.00 Total Credits 30.00
Total Tax 0.00 Total Tax 0.00
INVOICE TOTAL 480.90 INVOICE TOTAL 55.50
Ref Voided Invoice# 0116587 Ref Voided Invoice# 0116588
PAYMENT PAYMENT
INVOICE# PAYMENT TYPE AMOUNT INVOICE# PAYMENT TYPE AMOUNT
0946397 Cash /Check 480.90 0946397 Cash /Check 480.90
0946398 Cash /Check 66.50 0946398 Cash/Check 55.50
Total Cash/Check 536.40 Total Cash /Check 536.40
PAYMENT TYPE AMOUNT PAYMENT TYPE AMOUNT
Check# 5 536.40 Check# 5 536.40
nvlZ: 094639] 480.90 Inv 0946397 460.90
0946390 55.50 1nv#: 0946398 55.50
CJ
Z �)L -3 516) '15VI
ustomer's Signature Driver's Signature Customer's Signature Driver's Signature
'Your signature is acceptance that allthe product listed above was received 'Your signature is acceptance that allthe product listed above was received
and delivered in good condition" and delivered in good condition"
"Drivers cannot pickup product unless proper pickup form has been completed. "'Drivers cannot pickup product unless proper pickup form has been completed.
Not Responsible for shortage or breakage after merchandise is delivered and Not Responsible for shortage or breakage after merchandise is delivered and
accepted accepted
VALID VALID
scribedty 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
a Purchase Order No.
3 12 -3 7 ���r o �l e Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 6(P,
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.
a
ALLOWED 20
I N M F
f SUM O
"T7"77C�'
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
116 J-� 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
1
20 0
i natur
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund