211821 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 361540 Page 1 of 1
0 ONE CIVIC SQUARE JAKE LAIRD GOLF OUTING CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032 20491 COUNTRY PINE COURT
NOBLESVILLE IN 46062 CHECK NUMBER: 211821
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 26223 400 . 00 GOLF OUTING
INVOICE
August 10, 2012
City of Carmel Police Department
3 Civic Square
Carmel, IN 46032
Golf Outing $400.00
TOTAL AMOUNT DUE: $400.00
Please make check payable to:
Jake Laird Golf Outing
20491 Country Pine Court
Noblesville, IN 46062
INDIANA RETAIL TAX EXEMPT PAGE
City o C armel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26223
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
8=12
Jako Lmifd Golf Wing Caarmol Polico Dopall#mont
VENDOR
SHIP 3 Civic OquErs
20409 Country Pine Court TO C@ffnol, IN 46032
Noblecnillo, IN 42 (397)679-2
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-M2.00
9 Each golf outing $400.00 $400.00
Sub Total: $400.00
cu
°°
Send Invoice To: ✓ m
Carmel Police Dopa tmGnt
Attn:Torus@ Andomon
3 Civic Squm,.
Carmol, IN 4&2° PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept., PAYMENT x.00
F
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROP� ICI I NT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. (at e
of Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO- 26223 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.^_---_-__WARRANT NO. _-
ALLOWED 20
IN THE SUM OF$
S
C
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
20
Signature
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))
08/10/12 golf outing $400.00
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
Jake Laird Golf Outing
IN SUM OF $
20491 Country Pine Court
Noblesville, IN 46062
$400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Gift Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26223 -852.00 $400.00
I hereby certify that the attached invoice(s), or
I
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, August 10, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund