209455 06/05/2012 *F CITY OF CARMEL, INDIANA VENDOR: 131130 Page 1 of 1
0 ONE CIVIC SQUARE HINCKLEY SPRINGS CHECK AMOUNT: $17.56
CARMEL, INDIANA 46032 PO BOX 660579
DALLAS TX 75266 -0579 CHECK NUMBER: 209455
CHECK DATE: 6/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4239099 267785902041 17.56 OTHER MISCELLANOUS
www.HinckleySprings.com
Upcoming Delivery Dates
$Incid
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February March
A rll SEpnng�r' Bottled Water R Filtr Coffee
Thursday, 16 Thursday, 1 Thursday, 12
Thursday, Every time
Y, Thursday, 26 you purchase Athena bottled water, you join the
Thursday, 29 fight against breast cancer. A minimum of $1 million related
to the sale of Athena will 90 to support breast cancer
awareness, education, and research by 2014.
Customer Account 17220042677859
KIM ROTT
CARMEL CITY COURT invoice Date: 12
1 CIVIC SQ Invoice 02 -04 -12
CARMEL, IN 46032 Purchase Order 2677859 020
Date Transaction Details
Previous Balance Qty. Each Amount
01 -13 -12 P205195 Payment Check- 205195 Thank You 65.71
Remaining Balance -35.82
29.89
R120102494748 WHITE HOT AND COLD COOLER RENTAL
01 -19 -12 T120193042016 HINCKLEY SPRINGS 5G DRINKING WATER 1 "0 13.50 13.50�'�
5:0 GALLON BOTTLE RETURN 2 0 9 9 9 19.98
5.0 GALLON BOTTLE DEPOSIT -2 6.00 -12.00
Recd By: Not Available or Refused 2 0 6.00 12.00
02 -02 -12 T120333042011 HINCKLEY SPRINGS 5G DRINKING WATER
CUP PLASTIC FLAT 9 OZ HINCKLEY SPRINGS 50 CT 3 0 g 99 29.97 v'
5.0 GALLON BOTTLE RETURN 5 0 3.49 17.45 ti
5.0 GALLON BOTTLE DEPOSIT -3 6.00 -18.00
Recd By: Not Available or Refused 3 0 6.00 18.00
02 -02 -12 71403426 ENERGY SURCHARGE
1.0 2.37 2.37
Total New Charges
83.27
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Previous Balance Payment Total New Char es 30356 0036
$65.71 9 Pay This Amount
$35.82
$83.27 $113.16
Write the complete account number on your check. Detach remittance and mail with payment in the enclosed envelope. To pay online go to www.Hinckle S rin s.com
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172 20042677859* Late Fees May Apply After:
Y PP Y 02 -27 -12
6750 DISCOVERY BLVD. Total Amount Due: $113.16
MABLETON, GA 30126
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
(,P/ Purchase Order No.
0 57 Terms
1 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
v 1 419, ri J S
Total /7.
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
IN SUM OF
:57e
ON ACCOUNT OF APPROPRIATION FOR
L'IJ
Board Members
PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1 02 37 0,92 7 S 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
3� 20
Z_
Titl
Cost distribution ledger classification if
claim paid motor vehicle highway fund