213114 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $171.20
CARMEL, INDIANA 46032 PO BOX 299
WABASH IN 46992 CHECK NUMBER: 213114
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 000736 171 . 20 GARAGE & MOTOR SUPPIE
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200503'8381 800992'3495 Fax 260-563-3021 PATRON
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Hamilton Petroleum =========== VASE 1
16222 Allisonville Road INVOICE INVOICE NO. 000736
Noblesville IN 46060 =========== ORDER DATE 09/14/12
ACCOUNT NO. 0000921720
BATCH 469 RKB
CARMEL STREET DEPT
3400 W 131ST STREET
CARMEL IN 46074
================================================================================
P. O. # SHIP DATE TERMS SLS LOC
________________________________________________________________________________
09/14/12 Due 10/20/2012 RKB 256
================================================================================
PACKAGES SOLD DESCRIPTION UNITS SOLD UNIT PRICE EXTENDED
________________________________________________________________________________
4073505 ADV SUP PERFORM GREASE—TUBES 40 LB 4. 2800 171. 20
TOTAL DUE $$ 171. 20
RECEWED
==========
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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))
09/14/12 000736 $171.20
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
North Central Co-op
IN SUM OF $
P. O.. Box 299
Wabash, IN 46992
$171.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 1 000736 i 42-321.001 $171.20 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
Friday/September 21, 2012
— c Street Commissioner
f v
Street Gom issloner
Cost distribution ledger classification if
claim paid motor vehicle highway fund