208550 05/02/2012 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CARMEL, INDIANA 46032 PO Box 2856
CHECK AMOUNT: $242.90
KOKOMO IN 46904 -2856
CHECK NUMBER: 208550
CHECK DATE: 512/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 242.90 FOOD BEVERAGES
M'EROCA INVOICE
BEVERAGE CITY OF CA.RMEL.
dba BROOKSHIRE GOLF CLUB
INC. 121.20 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856 RR29 3 542 E X H
765- 459 -311:7
800- 382 -0675
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
04/27/12 481461 Dustin Smith 13 800 1,3
BASE October 3, 2011
PROMO #0412
PUMP $40/$33 REFUNDABLE
470 1 Shock Top Ale 1 /6.BBL 37.2.5 30.07 67.25
1/4 Barrels 1
TOTAL SALE 67.25
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00 I
9270 IMPORT PUMP DEPOSIT 33.00 K
67.25
CREDITS
Cash EFT Escrow Check Number O D
Dri /���/I R K[F1'Y\ 1 1 ()-"x y Re ceived sy
MIIVIERICA INVOICE
B CITY OF CARMEL
INCA dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904 -2856 RR2903542 EXP. 07/13/12
765- 459 -3117
800- 382_ -0675
Fax: 765- 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ..,ROUTE
05/03/12 481881 Dustin Smith 13 800
PRODUCT QUANTITY DESCRIPTION AMO
•D
BASE October 3, 2011
PROMO #0512
Pump $40/$33 Refundable
109 3 Budweiser 24 Lse Can 17.30 51.90
7025 5"" Goose Wheat 312 2/12 Can 24.75 123.75
7�
Q
1
Cases 8
PR OD: TOTAL SALE 175.65
10303 EMPTY AB 1/6 30.00
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00 N
9270 IMPORT PUMP DEPOSIT 33.00 K
175.65
T OTAL RETURNS
CREDITS
El Cash ❑EFT ❑Escrow y Check Number S
Driver :y �1� Received By
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/27/12 481461 Beer $67.25
05/03/12 481881 Beer $175.65
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
Mid America Beverage Inc.
IN SUM OF
P.O. Box 2856
Kokomo, IN 46904 -2856
$242.90
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 481461 42- 390.40 $67.25 1 hereby certify that the attached invoice(s), or
1207 481881 42- 390.40 $175.65 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
Friday, May 04, 2012
4-A A
Director, Brooksha Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund