212639 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
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CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $10.51
INDIANAPOLIS IN 46278 CHECK NUMBER: 212639
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 12598 10 . 51 OTHER EXPENSES
= �
vrrvniiuwvvi HYCIUH PAYMENT ----------------------
RRE EM INVOICE DATE IN' �^rE B BALANCE N 'SHIPPED RETURNED ENDING LEASED 6AUDAYS' CYLINDER _
P IT BALANCE CYLINDERS RATE AMOUNT 4
R ALY ACETYLE E 1 0 0 1. 1 0 .379 .00
R MIX MIX GASES 1 0 0 1, 1 0 .339 .00
R NIT NITROGEK 1 0 0 1 0 31 .339 10.51
R OXY OXYGEN 1 0 0 1 1 0 .339 .00
R SHP SMALL HIGH PRESSURE 1- 0 0 1- 0 0 .339 .00
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TAX: .00
CARMEL WATER CUSTOMER: 12598 TOTAL ® 10.51
3450 W 131ST ST INVOICE: 08203180
CARMEL IN 46074-8267 INVOICEDATE: 08/31/12
TOTAL CYL VALUE: 1200. 00 P/O:
INDIANA OXYGEN COMPANY 4627$=0588
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VOUCHER # 122059 WARRANT # ALLOWED
154252 IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
12598 01-6360-03 $10.51
Voucher Total $10.51
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
154252
INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 ' Due Date 9/6/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/6/2012 12598 $10.51
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
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Date T 6f Oicer