217073 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 357200 Page 1 of 1
` ONE CIVIC SQUARE CANNON IV, INC CHECK AMOUNT: $430.08
CARMEL, INDIANA 46032 PO BOX 697
INDIANAPOLIS IN 46206-0697 CHECK NUMBER: 217073
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4230200 INV331817 430 . 08 OFFICE SUPPLIES
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Invoice No: INV331817
Date: 1/25/2013
9SO Dorman Street Indianapolis, [N462O2'3S44
P: 317-951'0500 F: 217'951'0600 Account No: 5712414
Bill To: City OfCarmel Ship To: City OfCarmel
One Civic Square Attn: Terry Crockett
Carmel, IN 46032 Three Civic Square
USA Carmel, IN 46033
010W Ims"PRif
CnI102-21 Best way Net 30 Days
NE.10
Mark Benefiel
WE-
05054A HPD3 4000 BLACK PRINTHEAD 1.0 1.0 0.0 EA $154.78 $154.78
Model: 01273A
C5059A HP#90 7175ml Black Ink Ctg 1.0 1.0 0.0 EA $253.13 $253.13
PLEASE REMIT ALL PAYMENTS TO: Subtotal $407.91
CANNON IV, INC. Discount $0.00
P.O. BOX 697
INDIANAPOLIS, IN 46206-0697 Freight $22.17
Sales Tax $0.00
Past due amounts are subject to a Finance Charge of Invoice Total $430.08
1 1/2% per month (18%APR). Balance Due
Page 1 of 1
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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))
01/25/13 INV331817 $430.08
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
Cannon IV
IN SUM OF $
950 Dorman Street -
Indianapolis, IN 46202-3544
$430.08
ON ACCOUNT OF APPROPRIATION FOR -
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1202 I INV331817 I 42-302.00 I $430.08 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, February 04, 2013
Director , IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund