215259 12/10/2012 f CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WEX BANK
e ;?a CARMEL, INDIANA 46032 PO Box 6293 CHECK AMOUNT: $133.75
CAROL STREAM IL 60197-6293 CHECK NUMBER: 215259
CHECK DATE: 1211012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 31309517 133 . 75 0496-00-138002-1
I nvoi cue Statement
INVOICE NUMBER:Nc.) ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
04915-M138002-1 11,550.00 30 1 NOV-30 2012 DEC-26-2012 133.75
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
NOV-30-2012 FUEL PURCHASES 273.63
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
D
10 2012
By
PURCHASES,RETURNSAND PAYMENTSMADE JUST PRIORTO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICE/STATEMENT.
PREVIOUS BALANCE PAYMENTS (,)PURCHASES (+)DEBITS CREDITS + LATE FE = NEW BALANCE
139.88 0.00 273.63 0.00 0.00 0.00 133.75
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a monthly rate of RATE of fee for this period which is
2.08 % 24.99 % 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
TO NSURE�C�DIT TEAS AT PERFORATION AND INCLUDE BOTTOM_PORTIOIV WITH YOUR PAYMENT.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fleet Services
IN SUM OF $
PO Box 6293
Carol Stream, IL 60197-6293
$133.75
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 31309517 42-314.00 $133.75
I 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
Monday, December 10, 2012
Director, Administration
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))
11/30/12 31309517 $133.75
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