212671 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE&AUTO SVC
CARMEL, INDIANA 46032 1310 W SOUTH ST CHECK AMOUNT: $1,429.88
LEBANON IN 46052 CHECK NUMBER: 212671
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 LOOA3U 1, 429 . 88 AUTO REPAIR & MAINTEN
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 08/31/12 01:59 PM
1310 W. SOUTH STREET LEB file#: 0013098 Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: LOOA3U L00259 1 ST 10TH
Sold-To: Ship-To: Type - Payment
CARMEL FIRE DEPT $
2 CIVIC SQUARE $
C_AR_MEL, IN 46032
Total $ 0.00
REP 317-664-0958
317-571-2615
!R! SCU;UNIT C;BOX 21, .59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
2 2 GY756141614 315/808225 L G289 WHA DURASEA 621.69 1243 .38 202
dot# MJ72PWAW0212, MJ72PWAW0212
2 2 EPA STATE TIRE FEE (INDIANA) 0.25 0.50 202
2 2 BALANCE EQUAL BALANCE 18.00 36.00 202,220
2 2 041263000 NEW VALVE STEM 4 .50 9.00 202
1 1 046100000 UNIT #41 0 .00 0.00 202, 220
2 2 046100000 MT- DISMOUNT 28 . 00 56.00 202, 220
1 1 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 85.00 202, 220
1 1 047100000 MILEAGE 8915 0.00 0.00 202,220
1 1 047100000 BOB VANVORST 0. 00 0.00 202,220
V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$1429.88
IN GOV'T, 0. 000o
$0.00
Total: $1429.88
NewPymt: $0.00
Total Due: $1429 . 88
Received By: SP:Terry Millikan
VOUCHER NO. WARRANT NO.
ALLOWED 20
Lebanon Tire
IN SUM OF $
1310 West South Street
Lebanon, IN 46052
$1,429.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1120 I LOOA3U I 43-510.00 I $1,429.88 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
SEP 10 201Z
Fire Chief
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))
LOOA3U A41 $1,429.88
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