213482 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS CHECK AMOUNT: $204.63
CARMEL, INDIANA 46032 PO BOX 877
BELMONT MS 38827 CHECK NUMBER: 213482
CHECK DATE: 1019/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0116287-IN 204 . 63 UNIFORMS
HALSEN PRODUCTS COMPANY
INVOICE PAGE: 1
P.O.BOX 877
BELMONT,MS 38827
NATIONWIDE 1.800-344-6696 INVOICE NUMBER: 0116287-IN
FAX 1-800-826-8839 9/24/2012
INVOICE DATE:
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
'TERMS_,_._
BONNIE UPS
Net 30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
BJM92K EACH 288 288 0 0.650 187.20
BROWN JERSEY GL VE
THANK YOU FOR YOUR ORDER ! ! Net Invoice: 187.20
Freight: 17.43
Sales 'Tax: 0.00
------------------
Invoice Total: 204 .63
Less Deposit: 0.00
204 .63
INVOICE BALANCE
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))
09/24/12 0116287-IN $204.63
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
Halsen Products
IN SUM OF $
P. O. Box 877
Belmont, MS 38827
$204.63
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 0116287-IN I 43-560.011 $204.63 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%October 05, 2012
/ A
Street Commissioner
JLfCCl UU11 11 1IIJ0IUI1cl
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund