214140 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CARMEL, INDIANA 46032 PO Box 2656 CHECK AMOUNT: $200.30
KOKOMO IN 46904-2856
CHECK NUMBER: 214140
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 200 .30 FOOD & BEVERAGES
MIWAMERICA INVOICE
BEVERAGE• CITY OF .CARMEL- . .
1��■ dba BROOKSHIRE GOLF CLUB
12120. BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904-2856
765-459-3117 RR2903542 EXP. 07/13/13
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
10/25/12 498946 Dustin Smith 13 800 13
ITY"I DEPOSIT AMOUNT
DESCRIPTI
ON PRICE
OD
BASE October 1 , 2012
PROMO #01012
PUMP $40/$33 REFUNDABLE
209 8 Bud Lt 24 Lse Can 17.80 142.40
909 3 Mich Ultra 24 Lse Can 19.30 57.90
Cases 11
TOTAL SALE 200.30
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00
9270 IMPORT PUMP DEPOSIT 33.00 ,N
200.30
RET,URNS • • Y
_ CREDITS
❑ Cash ❑ EFT ❑ Escrow Check Number
Driver���/2'/ Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$200.30
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 498946 I 42-390.40 I $200.30 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 26, 2012
Director, Brooksh off Club
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))
10/25/12 I 498946 I Beer I $200.30
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