212853 09/18/2012 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
€ ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
s.
CARMEL, INDIANA 46032 Po sox zass CHECK AMOUNT: $115.65
KOKOMO IN 46904-2856 CHECK NUMBER: 212853
CHECK DATE: 9118/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 115 . 65 FOOD & BEVERAGES
MIW1 31NIERICA INVOICE
BEVERAGE � CITY 0'F CARMEL
dba BRUOKSH'IRE -GOLF 'CLUB
INC■ 12120 BROOKSHIRE PARKWAY
_ CARMEL IN 46032
2755 Commerce Dr.
P.O. Box 2856
Kokomo, IN 46904-2856 RR2903542 -_ `"
765-459-31}17
800-382-6675
Fax: 765-467-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
09/20/12 495604 Dustin Smith 13 800 13
..-PRODUCT PRICE E - AMOUNT
-QUANTITY DESCRIPTION - D POSIT
' CODE.
BASE March 5, 2012
PROMO #0912
Pump $40/$33 Refundable
209 8 Bud Lt 24 Lse Can 17.30 138.40
470 1 �� Shock Top Ale 1/6 BBL 37.25 30.00 67.25
Cases 8 1/4 Barrels 1
�,PRQQ%90DE DESCRIPTION PRICE AMOUNT t
���? TOTAL SALE 205.65
10303 EMPTY AB 1/6 30.00
10304 EMPTY AB 1/2 30.00
10405 / EMPTY AB 1/4 30.00 �e�iDL/ A
9230 . PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00 205.65
ctl/ v
-- ��
� ® CREDITS
❑ Cash ❑ EFT ❑ Escrow 11kf Number U
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))
09/20/12 495604 Beer $115.65
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$115.65
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 495604 I 42-390.40 I $115.65 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
Director, BrogAire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund