214640 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 355466 Page 1 of 1
ONE CIVIC SQUARE KEITH FREER
CARMEL, INDIANA 46032 1413 N.FAIRVIEW STREET CHECK AMOUNT: $71.16
ALEXANDRIA IN 46001 CHECK NUMBER: 214640
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
851 5023990 71. 16 OTHER EXPENSES
'
Papa Johns
Restaurant #1485
10598 North College Avenue
InUianapu|io, IN 46280
(317) 846-7272
---------------------------------------------
Name: Carme| Fire Dept.
Address: 2 Civic
Carmel IN 46082
_____________
Order #: 0003 Mwme / Delivery
____________________
447332 2812'11'08 11:40 AM
Out Tim*: 11:53 AM
------------------_______--°~==�.-/~.
Card Type:
Account #: xx
Authorization #.: OUO85B
Reference #: 190579
Batch ID: 8
Subtotal : 20.33
Tax: 0.00
~^~~~~^~~=~~~^
Total : 20.33
20.33
TiP:
Tuza| �
Additional Tender Amt: 0.88
____________________
Any delivery fee charged is not a tip for
the driver. Please mward your Driver with
a tip for outstanding service.
-----------------------------------------
Customer Signature
--------------------------------------------
Merchant Copy
_ _ __ __ ___ ______ __ _ _ _
I agree to pay total amount according to
the card issuer agreement.
Thank You For Choosing
Papa .Johns
Text PJ1485 to 47272 (4PAPA>-
to gat local Text ufferst
MsA & Data rotos may apply.
Visit www.unpajohnx.uum for details.
1
r* er
M r 1rr
C), e value fo the
way aou 1 1`V0- _
1217 S. RANGELINE RD.
317-846-4818
YOUR CASHIER WAS SELF CHECKOUT
KRO ORANGE JUICE PC 4.69 F
1 @ 2/3.00
COKE CLASSIC 1 ,50 B
1 @ 2/3.00
A&W ROOTBEER PC 1 .50 B
1 @ 2/3.00
SPRITE 1 .50 B
1 @ 2/3.00
DIET COKE 1 .50 B
1 @ 2/3.00
DIET COKE 1 .50 B
GRDH APL TRY 14.99 F
PRSL VEG ORG - 5.99 F- --
BKRY DONUTS 3.99 F
KRO PLATES 2.19 T
SOLO PLSTCUP PC 4.19 T
KRO PPR NPKN PC 2.29 T
TAX 1 .13
TAX EXEMPTION 1 .13-
BALANCE 45.83
021 KROGER 4959
1217 S. RANGELINE RD.
CARMEL IN 46032
Purchase
TOTAL: 45.83
REFU: 008858
45.83
EXEMPTED SALES AMT 16.17
CHANGE 0.00
TOTAL NUMBER OF ITEMS SOLD 12
11/08/12 09:54am 959 85 28 999
We Value Your Feedback!
ENTER TO WIN ONE OF 20 $100 GIFT CARDS
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- about your recent visit lo Kroger-
Answer by Internet @
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You will need this receipt to respond
SURVEY ENTRY CODF
021 999
>3;?E if xaf 3f ik it!f�E�?E 3f 3f if i;�*i4 *c�.a*,f a,sxxs�Y4}-s
JOIN KROGER PLUS & BEGIN SOV1NG TODAY
YOU COULD HAVE SAVED $2.89
THANK YOU FOR SHOPPING KROGER
CUSTOMER SERVICE IS EVERYONE'S JOB.
LET ME KNOW HOW WE ARE DOING.
CHARL BECHEL, MANAGER
VOUCHER NO. WARRANT NO.
ALLOWED 20
Keith Freer
IN SUM OF $
$71.16
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 120-851.00 $45.83 1 hereby certify that the attached invoice(s), or
1120 120-851.00 $25.33 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
NOV 16 2012
® Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Irescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
vhom, 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))
$45.83
$25.33
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