208583 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 00353173 Page 1 of 1
ONE CIVIC SQUARE A F C INTERNATIONAL INC
CARMEL, INDIANA 46032 PO BOX 894 CHECK AMOUNT: $57.93
715C SW ALMOND ST
o CHECK NUMBER: 208583
DEMOTTE IN 46310
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 35218 57.93 OTHER EXPENSES
A[ AFC International Inc Invoice
PO Box 894
715C SW Almond St
1 RH TIONAL. INC DeMotte, IN 46310 Date Invoice#
4/20/2012 35218
Bill To Ship To
Carmel Waste Water Treatment Plant Carmel Waste Water Treatment Plant
Attn Accts Payable Attn Jeff Cooper/
760 Third Ave SW 9609 Hazel Dell Pkwy
Suite 110 Indianapolis IN 46280
Carmel IN 46032
P.O. No. Terms Due Date Rep Ship Via
Verbal /Jeff Net 30 5/20/2012 TGD 4/20/2012 UPS
Qty Shipped B/0 Cat. No. Description Price Amount
2 2 0 008 3022 -010 Water Trap Filter w/o adapter, pk /10 25.00 50.00T
1 1 0 Shipping Shipping Insurance Charges 7.93 7.93T
Tracking No
1z891ar30365094359
Subtotal $57.93
Thank you for your order. We appreaciate your business. If you have any questions, please Sales Tax
contact us at 1.800.952.3293 or fax 219.987.6826. Returns subject to a restocking charge. No $0.00
returns will be accepted without prior authorization. In states other than Indiana, AFC is not
registered to collect taxes. If taxes are due on this sale you will be obliged to pay them Tota directly to the various taxing authorities. $57.93
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
00353173
AFC INTERNATIONAL INC Purchase Order No.
PO BOX 894 Terms
DEMOTTE, IN 46310 Due Date 4/30/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/30/2012 35218 $57.93
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
Date Officer
VOUCHER 117237 WARRANT ALLOWED
00353173 IN SUM OF
AFC INTERNATIONAL INC
PO BOX 894
DEMOTTE, IN 46310
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
35218 01- 7202 -06 $57.93
Voucher Total $57.93
Cost distribution ledger classification if
claim paid under vehicle highway fund