211761 08/14/2012 �. CITY OF CARMEL, INDIANA VENDOR: 361108 Page 1 of 1
ONE CIVIC SQUARE H S B C BUSINESS SOLUTIONS COSTC
CARMEL, INDIANA 46032 PO BOX 5216 HECK AMOUNT: $22.94
CAROL STREAM IL 60197-5219 CHECK NUMBER: 211761
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350100 GOLF 22 . 94 7003-7311-0007-4683
#346 CAST L/ IN
6110 EAST 86 STREET
CASTLETON, 46250
MEMBER #1 1 91434655
RESALE ON
50787 KS 13GSI BAG 12.99
25248 SCRUB UB 9.95
RESALE TOTAL 22.94
NON RESALE TOTAL .00
TOTAL x%LI
VF CostCO Wholesale 22.94
-------------------------------------- .
XXXXXXXXXXXX4683 SWIPED
06/28/12 12:25
Seq#: 001275 APP#: 049542
Costco Wholesale ResP: AA
Tran ID#: 218002717000
Merchant ID 99034611
APPROVED - PURCHASE
AMOUNT: $22.94
0346 008 0000000042 0112
-=------------------------------------
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD = 2 .
CASHIER: ZEE A. REG# 8
M41-4:1i!�-*I K' 12:25 0346 08 0112 42
THANK YOU !
PLEASE COME AGAIN !
Please Direct Inquiries To: 1-800-220-8594 COSTCO
iIVE��ESAbE
umber.: Amon pateAcaodntN ' =
7003 7311;0007:4683 $49 92'< $26:98 $:00 08/20.12012
BIIUng.t?ate Credit:Llne Available Credit
07/26/20:12 $2;000 . $:1950 08<.:; --
TDD/Hearing Impaired: 1-800-365-0186
STATEMENT OF YOUR ACCOUNT
_...... ...... _.........................._.__ ........................... ....... __ ....._ ... ..... . _...._... . _
.
FINANCE;CHAFtGE;!SUM MAR Y —
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
Reg 00014 0.00000% 00.00% S.00 00.00% S26.98 S26.98 07/26/2012
Reg 00014 S1.53 0.00000% 00.00% S.00 00.00% S22.94 5.00 08/26/2012
ACCOUNT DETAIL
.......................................................................... ..........................................................................................................................
Transaction TetimactlOn::: InVOlce2 User P.0::: .....; Transaction
bate Descnptton ;; . Number ID Ndinber Amount
06/28/2012 COSTCO WHOLESALE-346 049542 00003 S22.94 °
00003 SUBTOTAL: S22.94 0
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Return the below portion with payment.For billing errors or questions please refer to the back of the statement. Page 1 of 2
i
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O.Box 4160,Carol Stream, IL 60197-4160.
You may telephone HSBC Business Solutions at 1-800-210-8115,but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
TCOSTCO
sm
ACCOUNT SUMMARY BALANCE SUMMARY
Mm
CURRENT.:; 1 29 DAYS PAST DU.E 30=59 DAYS PAST:!DUE Outstanding
Transaction $26.98
+New —
$26.98 $.00 $.00 Purchase(s)/Debit(s) $22.94
60-89 DAYS PAST?DUE 90 119:DAYS PAST DUE 120 149 DAYS PAST:DUE:? +New Fees $.00
+Finance Charges $.00
$.00 $.00 $.00 Payment(s) $.00
150 179 DAYS PAST DUE 180+;DAYS PAST DUE °—°
-.. Credit(s) $.00
$.00 $.00 =New Balance $49.92 —
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Page 2 of 2
s❑❑❑❑❑.❑O
❑ New address or phone number?
Please check box and complete reverse side.
i
Important Notice: Promptly review this statement and notify HSBC Business Solutions in writing of any errors or
unauthorized purchases. If you do not notify HSBC Business Solutions within 60 days of errors or unauthorized purchases,
this statement will be presumed to be correct.
Write to HSBC Business Solutions at P.O. Box 4160,Carol Stream, IL 60197-4160.
You may telephone HSBC Business Solutions at 1-800-210-8115,but it will not preserve your rights.
Notify HSBC Business Solutions in writing of the cancellation of a credit card or authorized user.
STMT222C(10/07)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS
AND NUMBERS ONLY!
CMMaName 0000r-i000l I loo
Email Address
❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑
Street f St e d Unit or PO BOX Number
F-]F ❑❑F aa❑❑FIaa❑❑❑❑ [:IF-]❑❑❑
Ci000000000000000000 State❑❑ zip
Business Phone
000/DOCl°0000
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))
07/26/12 049542 Cleaning Products $22.94
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
HSBC Business Solutions
IN SUM OF $
P.O. Box 5219
Carol Stream, IL 60197-5219
$22.94
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#i Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 049542 I 43-501.00 I $22.94 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
Tuesday, August 14, 2012
Director, Brookshir Go Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund