218479 03/25/2013 a CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $164.64
BELMONT MS 38827
CHECK NUMBER: 218479
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0117923-IN 164 . 64 UNIFORMS
1
HALSEN PRODUCTS COMPANY N tl OICE PAGE:
P.O.BOX 877
BELMONT,MS 38&97
NATIONWIDE 1-800-344-6696
FAX 1-800-826-8839 INVOICE NUMBER: 0117923-IN
INVOICE DATE: 3/8/2013
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE AMY LUNN
3400 W 131ST ST 3400 WEST 131 STREET
CARMEL, IN 46074 CARMEL, IN 46074
CONFIRM TO:
AMY
CUSTOMER P.O. SHIP VIA F.O.B. _ TERMS
AMY UPS
Net --30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
k EACH 288 288 0 0-. 500 144 .00
LT WGHT STRING KNIT GL LINER
Net Invoice: 144 .00
THANK YOU FOR YOUR ORDER ! !
Freight 20.64
Sales Tax 0.00
Invoice Total 164 .64
Less Deposit 0 .00
164 .64
INVOICE BALANCE
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))
03/08/13 0117923-I N $164.64
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
Halsen Products
IN SUM OF $
P. O. Box 877
Belmont, MS 38827
$164.64
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 I 0117923-IN I 43-560.01 I $164.64 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
? 1
T "rsd 2013
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund