209729 06/12/2012 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: $227.40
KOKOMO IN 46904 -2856
CHECK NUMBER: 209729
CHECK DATE: 6/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION
1207 4239040 227.40 FOOD BEVERAGES
a
MID31MERICA I NVOICE
BE dba -GOLF CLUB-
E INC. 12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
c P.O.eBox 2856
Kokom6, IN 46904 -2856 ,�1 \L /V 5541 n! v/ y
765- 459 -3117
800 382 -0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
06/14/12 485832 Dustin Smith 13 800 13
TY _P RICE DEPOSIT AMOUNT
BASE March 5, 2012
PROMO 0612
PUMP $40/$33 REFUNDABLE_
109 4 Budweiser 24 Lse Can 17.30= 69.20
209 8 Bud Lt 24 Lse Can 17.30 138.40
428 1 Lime A Rita 8 oz .2/.12 CN 20.00
v' 20.00
Cases 13
TOTAL SALE 227 .60
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY.AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00,
9270 IMPORT PUMP DEPOSIT 33.00 227.60
RETURNS TOTAL
j 0 CREDITS
Fl Cash El EFT [:1 Escrow /Check Number U
Driver e Received By
v
WNW%MlEltlCA INVOICE
i D P 0 0 K
M
2755 Commerce Dr. If 1- 6 0 2
P.O. Box 2856
Kokomo, IN 46904-2856
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
4 -12 Du's-1-jn
9%sli'm
75
p
F
2 4 C 7, 70
D j oc:� TF
TOTAL SALE
10303 EMPTY AB 1/6
30.00
10304 EMPTY AB 1/2 30-00 H
10405 EMPTY AB 1/4 30.00 A
10310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00 K
2 '2
0 CREDITS
�l Cash D EFT M Escrow El Number LZ
.4.
)river 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))
06/07/12 485212 Beer ($0.20)
06/14/12 485832 Beer $227.60
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
VOUCH NO. WA RRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF
P.O. Box
2856
Kokomo, IN 46904 -2856
$227.40
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 485212 42- 390.40 ($0.20) 1 hereby certify that the attached invoice(s), or
1207 485832 42- 390.40 $227.60 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
Thursday, June 14, 2012
Director, Brooks Ir Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund