210108 06/20/2012 *f CITY OF CARMEL, INDIANA VENDOR: 00350579 Page 1 of 1
ONE CIVIC SQUARE R T AUTO SUPPLY, INC
CHECK AMOUNT: $52.50
CARMEL, INDIANA 46032 516 S MAIN ST
SHERIDAN IN 46069 CHECK NUMBER: 210108
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 5802 -77479 22.50 TIRES TUBES
2201 4232000 5802 -77514 30.00 TIRES TUBES
O ry
INVOICE DATE INVOICE NO. DUE DATE DEFERRED PO NUMBER CHARGES CREDITS AMOUNT DUE
4/30/2012 PB- Statement PREV BAL 217.39 217.39
4/30/2012 PB- Statement PREV BAL 221.12 438.51
571/20'12, S ID- 7747.9 0,6/10:
J EFF STEW R I "5'0 461 01.
ID.�7.7514` 0�6�/10.„ 3.0.00 „x �K`:4'91.'0�1`
5/23/2012 PC- Payment 1 217.32 273.69
5/31/2012 FC- Finance Ch 06/10 3.87 277.56
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TOTAL PAYMENTS THIS PERIOD 217.32 PAY THIS AMOUNT
STATEMENT DATE CUST. NO. DEFERRED ACCT. TOTAL 90 Da s 60 Days 30 Days CURRENT
5/31/2012 2070 277.56 0.00 0.07 221.12 56.37
FINANCE CHARGE 1.750 PAST DUE
21.000 o ANNUAL PERCENTAGE RATE
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ORQUEST
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•AU-'{ 10' SUPPLY' INC PAGE 1
S16 S MAIN STREET REF 82080.
AUTO PARTS SkIERIDAN, IN 46065
(317)756 -4456
SERVING A WORLD IN MOTION"'
5802 -77479 2070
ANY PART RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT. SEE CARQUEST STORE FOR DETAILS OF THIS COAST TO COAST GUARANTEE.
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CITY OI=' CARMEL I,t`t ,OF. CAIRMEL
3400 W 131ST 3460 W 131ST
;ARMEL, IN 46074 �ARMEL, IN 46074
INVOICE NO. CUSTOMER NO. DATE I�L,,",
S802--77479
802 774 0,7�. S/1/2012 J FF STEWART I "M HARGE
E MFG. PART NUMBER ORDERED f
;.;MIS DISPOSAL R 9 4.17 2.50 1 .0.00 22. SO.::N!{I
„'T.-IRE DISPOSAL
WARRANTY DISCLAIMER: The manufacturers warramy, if any, constitutes the only warramy with respect to the sale of all goods. SELLER HEREBY EXPRESSLY DISCLAIMS ALL WARRANTIES, EITHER EXPRESSED OR IMPLIED,
INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICl1LAR PURPOSE. Seller does not authorize any person to grant any warranty or assume any liability by Seller.
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37. S3 PAY THIS 22.50
",}3 a 20 `PM D AMOUNT CHAR
1
CASHAEFUND-
Customer Name
Customer Phone
Customer Mailing Address:,
Original Cash Sale Invoice
Customer's Signature
Counterpro's Signature
Copriterpro's
Manager's Initials
This is a copipany policy to help verify cash refunds and thus safeguard our assets,
CARQUEST
'r R 8t T AUTCi` Ur'PL4`, INC PAGE 1
516 S "MAIN STREE=T REF*r 82.115-`
SHERIDAN,' IN 4606
.AUTO PARTS, i 3,17) 7 5 8-4456, t
�I -R.UING •A WL7FtLD, IN h10I It]N''
.S802_„77514 q �O70 ,3
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ANY PART RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT SEELCAROUEST STORE FOR DETAILS OFTHIS_COAST TO COAST GUARANTEE a
TT Y :QI G(~ltMEL H V 0_ LfiflWkl
.ARME:L., IN 46074 {�RMCL, IN 46074
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�ISMC]UNT''TIRE
WARRANTY DISCLAIMER: The rhamfacturer's'warrant if any, constitutes the only wane IN respect to the sale of all goods. SELLER HEREBY. EXPRESSLY DISCLAIMS ALL WARRANTIES, EITHER EXPRESSED OR IMPLIED
INCLUDING ANY IMPLIED WARRANTY�OF. MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Seller does not a thorin any person to grmt any warranty _or -assu e a y,liebil ty by Sella,
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CASH REFUND
Customer Name
Customer
Customer Mailing Address
Original Cash Sale Invoice V
Customer's Signature
Counterpro's Signature
Counterpro's
Manager's Initials
This is a cothpany policy to help verify cash refun(Ls and thus safepwid our assets.
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))
05/01/12 5802 -77479 $22.50
05/02/12 5802 -77514 $30.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
R T Auto Supply
IN SUM OF
516 S. Main Street
Sheridan, IN 46069
$52.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 5802 -77479 42- 320.00 $22.50 1 hereby certify that the attached invoice(s), or
2201 5802 -77514 1 42- 320.00 $30.00 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, June
yl 5, 2012
Street Commissioner/
Street TIt1e'nmissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund