214598 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD
CHECK AMOUNT: $23.50
l? CARMEL IN 46032
,o CHECK NUMBER: 214598
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4351000 136796 23 . 50 AUTO REPAIR & MAINTEN
622C S. Rangeline Road
"YOUARE RIDING ON OUR REPUTATION" 4ARIK Carmel, IN 46032
4w M� - 839
�Jational PENS
I,THE UNDERSIGNED,HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE
A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID.I FURTHER AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE,AND
IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHA E EQUAL TO THE COST OF COLLECTION INCLUDING
AGENCY AND ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BY LAWS GOVERNING THESE TRANSACTIONS.
A finance charge of 13/4%Per Month will be charged on all Accounts 30 days Past Due.Annual Percentage Rate is 21%.(Minimum 75) RECEIVED BY
SOLD TO:EAMEL CLAY PARKS AND REC �, 5-91i SHIP TO��,iE Th1UDICE# 136736
1411 E. 116TH SIREET
CAR#IEL IN 46032
CUST. P.O.# MAKE-MODEL ' ID# MILEAGE �(= TiELEPlQNE ROUTE SLM SHIP VIA ORDER# PAGE ' REMARKS
1317)571-4144 0 I N/A 150775 1
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
n' d _l_.
n_ a
10/24/2112 136756 NET 10TH 10/24/12 1x:49:35 7
DuANnry_,_______
STOCK NUMBER SIZE DESCRIPTION - UNIT T F.E.T. EXTENSION
_'.ORDERS SHIPPED PREV.SHIP PRICE
REP;I TIRE LOOSE
7L0-8190
16 16° DISMOUNT MOUNT PASSENGER 1 1 16.00 .00 16.a
REP EACW1 INSIDE TIRE REPAIR 1 1 7.50 .00 7.50
"IIIETHOD OF PAYMENT:
CKRSE: 2159
CHAN0E. .00
RF`
PUrdMe
OCT
P.a a ----. -Q.: .
PorF
WOO
Budget
Line Des 12S -
Purchas
Date (6
r Approval
Date 0)_ Z
7hailk you for your business rieen: Mki
PARTS LABOR 10 TAXABLE OUNT TAX F.E.T. AMOUNT PCFASE P!IN E T;O}TAIr
23.50
"You're Riding On Our Reputation"
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.
060700 Clark Tire Terms
622C S Rangeline Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
10/24/12 136796 Tire repair P10 $ 23.50
Total $ 23.50
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.
060700 Clark Tire Allowed 20
622C S Rangeline Rd
Carmel, IN 46032
In Sum of$
$ 23.50
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 136796 4351000 $ 23.50 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
15-Nov 2012
Signature
$ 23.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I