215359 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE&AUTO SVC
CARMEL, INDIANA 46032 1310 W SOUTH ST CHECK AMOUNT: $130.00
LEBANON IN 46052 CHECK NUMBER: 215359
CHECK DATE: 12/11/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 LOOCOV 130 . 00 TRANSPORTATION EXPENS
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 11/29/12 10:37 AM
1310 W. SOUTH STREET LEB file#: 0015583 Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: LOOCOV L02634 1st 10th
Sold-To: Ship-To: Type - Payment
CARMEL WASTE WATER $
9609 HAZEL DELL RD $
INDIANAPOLIS, IN 46280
Total $ 0.00
REP 317-571-2634
!R! SCU;UNIT C;BOX 21, .59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
1 1 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 85.00 202,220
2 2 041263000 NEW VALVE STEM 4 .50 9.00 202
1 1 046100000 mt- dismount 36.00 36.00 202,220
1 1 046100000 per jeff cooper 0.00 0.00 202,220
--------------------
V/Info:
------------------------------------------------------------------------------------------------
D Sub-Total
E//V� Q e isr enc/ I p4t.r fo �o1 $130.00
Sales Tax
D ` ` +0 PAY $0.00
389-f Total: $130.00
NewPymt: $0.00
Total Due: $1.30_. 00_ - ------ -
Received By: SP:Terry Millikan
VOUCHER # 126284 WARRANT # ALLOWED
182450
IN SUM OF $
LEBANON TIRE & AUTO SVC
1310 W SOUTH ST
LEBANON, IN 46052
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
LOOCOV 01-7502-06 $130.00
Voucher Total $130.00
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
182450
LEBANON TIRE &AUTO SVC Purchase Order No.
1310 W SOUTH ST Terms
LEBANON, IN 46052 Due Date 12/6/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/6/2012 LOOCOV $130.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audit ed same in accordance"'with IBC 5-11-10-1.6
/
Date Officer