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216375 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1 i 0 ONE CIVIC SQUARE CLARK TIRE INC CHECK AMOUNT: $80.00 CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CARMEL IN 46032 CHECK NUMBER: 216375 CHECK DATE: 1/15/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4351000 137231 80 . 00 AUTO REPAIR & MAINTEN Clark Tire Company 317-844-6561 p.1 622C S. Rangelxne Road DARE RIDING ON OUR REPUTATION" LARK Carmel, IN 46032 RE (317) 844-4839 ationa6 PE OIL 1,THE UNDERSIGVFD,HFREBY AGREE L-,nL SUCH TISfE AS THISACCOUNT 15 PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE A SECURITY INTFR EST IN SAID GOODS TO SECURE THE PAYMENT UNTIL-MY ACCOUNT IS FULLY PAID.I FURTHER AGREE TILAT IN THE EVINT OF DEFAULT IN THE P.AYM ENT OF ANY AMOUNT DUE,AND IF THIS ACCOUNT 1S PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING AGENCY AND ATTORNEY FEES AND COURT COSTS INCJRRED AND PERMITTED BY LAWS GOYERNING THESE TRANSACTIONS. A finance charge of 13,4%Pcr.Month will x charged on all Accounts 30 daps Past Dut.Annual Pcmcnlagc Rate is 2'S:-(Minimum 75) RECEIVED BY SOLD IO AZT -IF DEPT. 5902/01 SHIP T NE IRVOICE# 13721 �n Y4EL iN 0210 COST.P.O.# MAKE-MODEL ID# MILEAGE NE ROUTE SLM SHIP VIA ORDER# PAGE REMARKS 571-2609 0 5 N/A 151785 1 INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS NUMBER INVOICE NUMBER 12!18/2812 137231 NET 10TH tr/±Bi12 16:06:+° 8 STOCK NUMBER SIZE DESCRIPTION OSHIP'ry 1 T F.E.T. EXTENSION ORDERS SHIPPFq PREV.SHIP�� PRICE SWAP OUT TIRES AMBULANCE #42 GOOD -/RES AMBULANCE #49 WORE OUT TIRES ROTATE EACH TIRE ROTATION B 8 10.00 .92 80.00 IETHOD CE PAWIENT: IIARGE: 84,30 NA11GE: 0a �1 T ank you for your businEss MecI; bill 8 Mike PARTS LABOR TAX°� --00�� TAX F.E.T, nM-Urrr PI FA.,, QV FEWj ---- 90,U+2 L 0"12'0155-ut��-0 B©.630 I "You're Riding On Our Reputation" prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n 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)) 137231 Amb.40 $80.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Clark Tire IN SUM OF $ 622 South Rangeline Road Carmel, IN 46032 $80.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 137231 I 43-510.00 I $80.00 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 jAN 14 d Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund