215618 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 00350527 Page 1 of 1
0 ONE CIVIC SQUARE DON'S AUTO TRIM CHECK AMOUNT: $895.00
CARMEL, INDIANA 46032 5397 ROCKVILLE ROAD
INDIANAPOLIS IN 46224 CHECK NUMBER: 215618
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 103584 895 . 00 REPAIR PARTS
MW AM T=
V� zxax C44" N® 103584
5397 Rockville Road • Indianapolis, IN 46224
(317) 227-0988 Office • (317) 227-0977 Fax
Customer's
Order No. atAT-/ 201..-
M
Address
City State
SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE.RETD. PAID OUT
QUAN. DESCRIPTION PRICE AMOUNT
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o
ALL CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL
Received By / i
V�
VOUCHER NO. WARRANT NO.
ALLOWED 20
Don's Auto Trim
IN SUM OF $
5397 Rockville Road
Indianapolis, IN 46224
$895.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I 103584 I 42-370.00 j $895.00 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
rN 1
FridayjDejcem b, er�i,1'4, 2012
S_rEStreet:Commissioner
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))
12/14/12 103584 $895.00
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