215401 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 264001 Page 1 of 1
ONE CIVIC SQUARE RED WING SHOE STORES INC
CHECK AMOUNT: $66.49
CARMEL, INDIANA 46032 6653E 82ND ST
INDPLS IN 46250 CHECK NUMBER: 215401
CHECK DATE: 12/11/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4239012 51039751 66 .49 SAFETY SUPPLIES
Sft
Red Wing Shoo Store
Cast eton Village
6653 East 82nd St.
Indianapolis, IN 462504577
(317)577-0760
11/30/12 16;29 00051039751
Sold By Employee #80200
CONN, -ANGIE (317)571-2417
STORE COPY
SALES
06513M 060 CHUKKA, BLACK, 6513 69.99
Safety Footwear
Major/Nat'l Account 5% -3.50
MA Exempt Govt Agency
0031201550020
SUB-TOTAL 66.49
7.00% SALES TAX 0.00
TOTAL $66.49
I
Major Account Charge 66.49
Sold Items 1
CITY OF CARMEL/COMMU
1 CIVIC SQUARE
CARMEL, IN 46032
(317)571-2418
I ACKNOWLEDGE THAT THIS SALE COMPLIES
WITH THE CONDITIONS OF THE AGREEMENT MADE
WITH THE MAJOR ACCOUNT
X aft; ( �
CONN, ANGIE
0000510397510
VOUCHER NO. WARRANT NO.
ALLOWED 20
Red Wing Shoe Store
IN SUM OF $
Castleton Village, 6653 East 82nd Street
Indianapolis, IN 46250-4577
$66.49
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. CT#/TITLE AMOUNT Board Members
1192 I 00051039751 I 42-390.12 I $66.49 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
Monday, December 10, 2012
e
or
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 00051039751 Safety boots-Angie Conn $66.49
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