213295 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WRIGHT EXPRESS FSC
CARMEL, INDIANA 46032 PO Box 6293 CHECK AMOUNT: $376.65
< ? CAROL STREAM IL 60197-6293 CHECK NUMBER: 213295
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 30724824 376 . 65 0496-00-138002-1
I nvoi ce Statement
INVOICE NUMBER: 30724824
ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00-138002-1 1 550.00 30 SEP-30-2012 OCT-:6 2012 376.65
DATE ACTIVITY DESCRIPTION 'CHARGES/DEBITS PAYMENTS/CREDITS
SEP-13-2012 PAYMENT-THANK YOU 155.70
SEP-28-2012 FUEL PURCHASES 376.65
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
li
OCT 0 0 2012 -
PURCHASE$RETURNSAND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS + PURCHASES (,)DEBITS CREDITS + LATE FE = NEW BALANCE
155.70 155.70 376.65 0.00 0.00 0.00 376.65
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a monthly rate of RATE of fee for this period which is
2.08 % 24.99 % 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
TO FNq IPF PP()PFP r pr=nlT TPAP AT PFPP0PATIr)N AA1T1 Wr 1 1 Ir)P Rr)TTr1RA PnPTlnl l 1A/ITN Vr)l IP PAVMFAIT
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF $
PO Box 6293
Carol Stream, IL 60197-6293
$376.65
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 30724824 42-314.00 $376.65 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
Mon ay, October 08, 2012
Directo , Administrati n
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))
09/30/12 30724824 $376.65
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