210955 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
`F. ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
'
CARMEL, INDIANA 46032 Po eox 2856 CHECK AMOUNT: $158.35
KOKOMOIN 46904-2856 CHECK NUMBER: 210955
CHECK DATE: 7/1712012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 158 . 35 FOOD & BEVERAGES
M0ER1CA INVOICE
BEVERAGE. . . . . . . CITY dF1EARMELi ` , . _ - . - , - , 1 ,
1��■ dba -BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL ' IN 46032
P.O. Box 2856
Kokomo, IN 46904-2856 RR2903542 EXP. 10/13/12
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
07/19/12 489317 Dustin Smith 13 800 - 13
s® DESCRIPTION: PRICE" .,DEPOSIT -AMOUNT
BASE March 5, 2012
PROMO #0712
PUMP $40/$33 REFUNDABLE
YSS�r;?�✓tom`'�`�: .` _
109 2 Budweiser 24 Lse Can 17 .30 ` '" 34.60
209 5 Bud Lt 24 Lse Can 17.30 = 86.50
408 2 'r Bud Lt Lime 2/12 Can 20.60 41 .20
909 V Ultra 24 Lse Can. 18.80 18:80
,f
75 -
1
Cases 10
--oe •. • . - • AMOUNT
TOTAL SALE 181 • lt7
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
.9270- IMPORT PUMP DEPOSIT 33.00
181 .10
Raw
® CREDITS
❑ Cash ❑ EFT ❑ Escrow Q Check Number U •
lo—
Driver _ ��� Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$158.35
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1207 I 489317 I 42-390.40 I $158.35 1 hereby certify that the attached invoice(s), or
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, July 19, 2012
Director, Brook re Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
07/19/12 489317 Beer $158.35
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