213969 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 366665 Page 1 of 1
0 ONE CIVIC SQUARE INDY CUSTOM CORNHOLE
CARMEL, INDIANA 46032 2836 WESTLEIGH DRIVE CHECK AMOUNT: $177.00
INDIANAPOLIS IN 46268 CHECK NUMBER: 213969
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 10/4/12 177 . 00 GENERAL PROGRAM SUPPL
OCT 0 9 2012
V.
%
' Indy Custom Cornho(e INVOICE
Indiana's Premiere Cornhole Supplier DATE: OCTOBER 4, 2012
Please Remit:
2836 Westleigh Dr
Indy IN 46268
DONATED TO:: Carmel Clay Parks
Attn: Dawn Koepper
PAYMENT METHOD CHECK N0. SPECIAL INSTRUCTIONS
_..... N/A PO H(200 3-5-75
_....._._.... _ ..... ......... .__.. ... ..__.. ..._........- ----............- - --........ . . - _
QTY ITEM# DESCRIPTION UNIT PRICE DISCOUNT - LINE TOTAL
4 sets of blue and red Resin bags 4 � Resin bags g E 36.00 0.00 f 144.00
1 ; Delivery Delivered sets to facility 33.00 ; 0.00 1 33.00
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'Sales tax exempt certificate on file. SALES 0.00
I TAX I
TOTAL 177.00
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We are located at Midwest Sports Complex - 7509 New Augusta Rd Indy IN 46268
IndyCustomCornhoIe.com (317) 339-0780
Purchase _... . .......
Description
P.O.# M C O C P ol)
G.L.#
Budget
Line Descr
Purchaser Date
Approval Date THANK YOU FOR YOUR BUSINESS!
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
Indy Custom Cornhole Terms
2836 Westleigh Dr
Indianapolis, IN 46268
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
10/4/12 10/4 Corn hole resin bas $ 177.00
Total $ 177.00
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.
Indy Custom Cornhole Allowed 20
2836 Westleigh Dr
Indianapolis, IN 46268
In Sum of$
$ 177.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-50 10/4 4239039 $ 177.00 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
18-Oct 2012
Signature
$ 177.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund