213634 10/09/2012 �=,f CITY OF CARMEL, INDIANA VENDOR: 00352664 Page 1 of 1
0 ONE CIVIC SQUARE RELYCO SALES INC CHECK AMOUNT: $452.71
CARMEL, INDIANA 46032 121 BROADWAY
oM.�a DOVER NH 03820 CHECK NUMBER: 213634
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4230200 SIN022710 452 . 71 MICR TONER
7TEZYCO 121 Broadway•Dover,NH 03820 INVOICE
T(800)777-7359•(603)742-0999
® F(603)742-9993•E info @relyco.com Invoice Number: SIN022710
www.relyco.com Invoice Date: 09/26/2012
Due Date: 10/26/2012
Purchase Order#: C.Sheeks
Payment Terms: 1% 10 Net 30
Bill To:5081 Ship To:5081
CITY OF CARMEL CLERK TREASURER CITY OF CARMEL CLERK TREASURER
One Civic Square Cindy Sheeks
Carmel, IN 46032-2584 One Civic Square
USA Carmel, IN 46032-2584
USA
Item Number" 'Description", ;QTY. UOIVI' aQTY' rUOIVI° "" Ship'Via;<aJnit,:Price ExE.=Price:
Ordered- `Shipped,
02-81136-001 HP 4250/4350 TROY SECURE HY 1.00 EA 1.00 EA UPS $437.00 $437.00
MICR TONER CARTRIDGE Ground
Insured
Sub Total $437.00
Shipping& $15.71
Handling
Sales Tax $0.00
Invoice Total $452.71
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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))
Total
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.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.—
ALLOWED 20
L�CIO
IN SUM OF $
$ OD
ON ACCOUNT OF APPROPRIATION FOR
UU
Board Members
PO#or
DEPT.# INVOICE NO. ACCT#ITITLE AMOUNT I hereby certify that the attached invoice(s), or
-Iol S!Qo-2-L-?w 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
20
`� Signat
U6/
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund