209456 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC CHECK AMOUNT: $188.45
a CARMEL, INDIANA 46032 PO BOX 2856
KOKOMO IN 46904 -2856 CHECK NUMBER: 209456
CHECK DATE: 6/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 188.45 FOOD BEVERAGES
MIWOLMERICA I NVOICE
B CITY OF CARMEL
ININC. ba BROOKSH I RE GOi4IF CLUB
CE BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, 9o4 -2856
765- 459 -3117 9 -3117 RR2903542 EXP. 07/13/12
765
800 382 -0675
Fax: 765 457 -7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
06/07/12 485212 Dustin Smith 13 804 13
F�IR666d NT
QUANTITY DESCRIPTION PRICE DEPOSIT 'AMOU
BASE March 5, 2012
PROMO 0612
PUMP $40/$33 REFUNDABLE
209 10 y Bud'Lt 24 Lse Can 17.30 173.00
470 1 J Shock Top Ale 1/6 BBL 37.25 30.00 670 25
i
Cases -10 1/4 Barrels 1
TOTAL SALE
240.25
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
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00 240.25
1 CREDITS
Cash EFT Escrow Check Number U
Driver v Received By
NI
INVOICE
CITY OF CARMEL
dba BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
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
05/24/12 483883 Dustin Smith 13 800 13
IN
e 1 o •e e
r APPROVED BY THE STATE BOARD OF ACCOUNTS FOR'THE CITY -OF CARMEL 2002 CHECK NO
PAYABLE AT
r Y
tITI(OF CARMEL DI
„INANA FIFTH THIRD BANK 71 859 t� 209258
INDIANAPOLIS INDIANA 749 r s r
SQUARE
k ONE CIVIC: DATE ¢5/22/2012
f�CARMEL INDIANA 46032 GENERAL ACCOUNT
g k�
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Y #�k� AMT`
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'zPAY 9 O t `',F r s 't x y µas+4
u, FIVE THREE EIGHi��
al s s THIS WARRANT IScV01DrcTW0 (2) YEARS AFTER
DECEMBER 3l OF THE YEAR OF ISSUE 3
Toy
MIDAMERICA BEVERAGE INC
They PO BOX 2$56 Y g h a CLERK TREASURER °"f
II' 209 2Salim 1:074908S941: 9 9 93L. 27u■
Y s�
4 y p Qp1p
51 6 9 0 9
MID AMERICA OWES
YOU OWE
aes 26 1/4 Barrels 1
•-ae e� e e a
TOTAL SALE 546.90
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 3ej ev A
1`0310 EMPTY IMPORT 1/2 30.00 N
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 83.00 546.90
D,OD
Y CREDITS
O r
Cash EFT Escrow Check Number tJ
Driver 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))
05/24/12 483883 Beer ($22.00)
06/07/12 485212 Beer $210.25
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
$188.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 I 483883 I 42- 390.40 I ($22.00) 1 hereby certify that the attached invoice(s), or
1207 I 485212 I 42- 390.40 I $210.25 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 07, 2012
Director, Brooks We e Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund