218991 04/09/2013 `'*f CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH-BROOKSHIRE GOLF CO�q�
`, =a CARMEL, INDIANA 46032 C/O PAM LISTER GFiECK AMOUNT: $148.71
CHECK NUMBER: 218991
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4342100 9 . 20 POSTAGE
1207 4350000 603916 81 . 00 EQUIPMENT REPAIRS & M
1207 4239040 CLASSIC SPIR 23 . 97 FOOD & BEVERAGES
1207 4239040 ENTENMANNS 5 . 75 FOOD & BEVERAGES
1207 4239040 MEIJER 9 . 03 FOOD & BEVERAGES
1207 4239040 O'MALIA 19 . 76 FOOD & BEVERAGES
INVOICE
Grooms Tire Recycling INVOICE NUMBER
P. O. Box 319 • Plainfield, IN 46168
Office 238-0388 • Fax 238-5257 603916
INVOICE DATE j 6/TO �' � �I .G 11 - 1 - 13
PO #
COD ❑ 10th Prox. ❑
QUANTITY DESCRIPTION PRICE AMOUNT
Minimum Pickup Charge
Truck Tires
Mounted Truck Tires
Car Tires
Q �
Mounted Car Tires
Pick-Up/SUV Tires
Mounted Pick-Up/SUV Tires
) 4 Z L i oo �
Off Road it A: size:
size:
size.-
Tires in kind may be returned and service charges billed if not
PAID according to terms.
.
X TOTAL '
�
�
SIGNATURE Thank You!
WASTE TIRE MANIFEST
Stale Form 47273(R2 170-06)
Indiana Department of Environmental Management
Rio
INSTRUCTIONS: 1. Use of this form is required by 3291AC 15-4-13 and IC 13-20-14-5.
2. The Waste Tire Transporter must complete this form for each shipment of waste tires.
3. Fill in af!information. Generator, transporter, and receiving facility information may be pre-printed
4. Give a copy of this form to the generator(source)of the waste tires.
5. Give a second copy of this form to the receiver of the waste tires as listed in IC 13-20-14-4.
6.Keep a copy of this form for your records for at least one(1)year.
7.For help with this form contact IDEM's Office of Land Quality, Solid Waste Permits Section, at(317)232-0066.
GENERATOR (SOURCE OF WASTE TIRES)
Name F� Telephone(including area code)
V-j/� �/ /,l ( '/ Z �lil e11 -MJ- 2/WA 1,56- b//l
Address f Generator's Prinr)Name
Authorized
City State Zip Code Agent Signa
A , ttrr�
DESCRIPTION OF SHIPMENT
Pickup Date Time Tire Types
Lellvl an A moue �O
❑ Passenger Tires, / ❑ Truck Tires
;Pickup Location Ll
I I I 1~. ^�p �❑ 1
r
- L'0acl Type ❑ Light Truck Tires ❑ Floats/Off Road Tires
checKone. ® Whole Tire Count ❑ Weight in Pounds g
J )
❑ Volume Cubic Yards ❑ Weight in Tons ,❑ ❑
TRANSPORTER
Name Telephone (including area code)
Grooms Tire Recycling, Inc. 317-238-0388
Address
1315 S. Drover St. Permit/Registration No. State
City State Zip Code 049-T-00053 Indiana
Indianapolis I IN 46221
I CERTIFY,UNDER PENALTY OF PERJURY AS PROVIDED IN IC 35.44.2.1,THAT THE MATERIAL DESCRIBED ABOVE WAS PICKED UP AT THE
SITE DESCRIBED ABOVE AND,TO THE BEST OF MY KNOWLEDGE,THIS INFORMATION IS TRUE AND ACCURATE.
— lot, At,1W
Driver's Name Signature
DESTINATION
Name Telephone(including area code)
Grooms Tire Recycling, Inc. 317-238-0388
Address
1315 S. Drover St. Permit/Registration No. State
City State Zip Code 049-P-00054 Indiana
Indianapolis IN 46221
I CERTIFY,UNDER PENALTY OF PERJURY AS PROVIDED IN IC 35.44.2.1,THAT THE MATERIAL DESCRIBED ABOVE HAS BEEN ACCEPTED
AND,TO THE BEST OF MY KNOWLEDGE,THIS INFORMATIO_N IS TRU ND A/CCURATE,AND THAT I AM AN AUTHORIZED AGENT OF THE
REGISTRANT.
Anver Grooms/Vicki Mitchell
Name of Authorized Agent Sig lake U Receipt Date
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$81.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 603916 I 43-500.00 I $81.00 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
Wednesday, April 03, 2013
Director, Brook ire Golf Club
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))
04/01/13 603916 Tire Recycling $81.00
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
CARMEL RETAIL STORE
CARMEL, Indiana
460329998
1740350814-0097
03/28/2013 (800)275-8777 08:57:22 AM
Sales Receipt
Product Sale Unit Final
Description Qty Price .Price
(Forever) 1 $9.20 $9.20
Four Flags
Double
Sided
Bklt/20
Total : $9.20
Paid by:
Cash $10.00
Change Due: -$0.80
BRIGHTEN SOMEONE'S MAILBOX. Greeting
cards available for purchase at
select Post Offices.
In a hurry? Self-service kiosks
offer quick and easy check-out. Any .
Retail Associate can show you how.
Order stamps at usps.com/shop or
call 1-800-Stamp24. Go to
usps.com/clicknship to print
shipping labels with postage. For
other information call
1-800-ASK-USPS.
Get your mail when and where you
want it with a secure Post Office
Box. Sign up for a box online at
usps.com/poboxes.
Bill#:1000300500781
Clerk:l5
All sales final on stamps and postage
Refunds-for guaranteed services only
Thank you for your business
HELP US SERVE YOU BETTER
Go to:
https://postalexperience.com/Pos
TELL US ABOUT YOUR RECENT
POSTAL EXPERIENCE
YOUR OPINION COUNTS
Customer Copy
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$9.20
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
1207 I I 43-421.00 I $9.20 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
Wednesday, April 03, 2013
Director, Brookshire Golf Club
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))
03/28/13 Stamps $9.20
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
W RALIA #206
4755 E. 126TH ST,
CARMEL., IN 46033
(3110844-4372
1854 N OWN HTOG BTR BUN PC 2.79 F
1854 N OWN HTDG BTR BUN PC 2.79 F
CUSTOMER NUMBER 40003033880
SC 713 N OWN H1'CIG BTR BUN 1 .54-F
SC 713 N OWN H1'OG BTR BUN 1 .54-F
** * TAX .00 BAL 2.50
CASH 20.00
CHANGE 17.50
TOTAL NUMBER OF ITEMS SOLD = 2
4/07/13 10: 16 AM 0206 03 0059 132
YOUR CASHIER WAS OLIVIA
)'10LI SAVED
$ :3 . 08 ( 55% )
ON YOUR ORDER TODAY
* ** * YOUR SAVINGS
COUPON PLUS SAVINGS 3.08
TOTAL SAVINGS (55%) 3 3.08
YOUR SAVINGS ** ***
THANK YOU FOR SHOPPING
011Al_IA
CHECK US OUT: ttttp://www.omalias.com
a:.
W MALIA #206
4755 E. 126TH ST.
CARMEL, IN 46033
(317)844-4372
CUSTOMER NUMBER 40020008370
2313 N OWN BTR HAM BUN PC 2.79 F
SC 713 N OWN BTR HAM BUN 1 .54-F
1854 N OWN HTOG BTR BUN PC 2.79 F
SC 713 N OWN HTOG BTR BUN 1 .54-F
1854 N OWN HTOG BTR BUN PC 2.79 F
SC 713 N OWN HTOG BTR BUN 1 .54-F
3368 VALUTI HOTDOG BUNS .99 F
**** TAX .00 BAL 4,74
CASH 5.00
CHANGE .26
TOTAL NUMBER OF ITEMS SOLD = 4
4/06/13 8,52 AM 0206 02 0012 121
YOUR CASHIER WAS ANNE
YOU SAVED
$ 4 . 62 ( 49% )
ON YOUR ORDER TODAY
YOUR SAVINGS ** *****#*
COUPON PLUS SAVINGS 4.62
TOTAL SAVINGS (49%) $ 4.62
****# **�► YOUR SAVINGS
THANK YOU FOR SHOPPING
O ' MALIA
CHECK US OUT: http://www.omalias.com
With your Marsh Fresh Idea Card
You saved
$124.89 in 2012.
You have saved
$43.65 in 2013.
Marsh Fresh IDEA Lard
required for all offers.
Thank you for Shopping
Marsh!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$7.24
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 O'Malia 42-390.40 j $4.74 1 hereby certify that the attached invoice(s), or
1207 O'Malia 42-390.40 $2.50 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, April 08, 2013
l
Director, Brook ire Golf Club
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))
04/06/13 O'Malia Bread $4.74
04/07/13 O'Malia Bread $2.50
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
f .
�
SPIRITS
��_ u��'�
�� ^p� u
03/25/13 #OOOOOi
38 ?.99
MIX 23.97
SUBTTL 23.9?
TAX i 1.68
TOTAL 25.65
CHASGE CRD 25.65
3 #ITEMG
OOii
#Oi #OOOi 11:37
PLEASE COME AGAIN!
`
`
O U KA IA #206 '
4755 E, -1126TH DT.
CHR�EL. I� 46033
' (317)O44-4373
` no oezoY J0on mcnm 5.69 F
3 @ 3/2.o0
1063 CALIF LEMONS 2.0 0 F
**** TAX oo DoL 69
________________---,_
O'MALTA #2Cl6 '
1755 E 126rx ST v '
�
CeRm[L. Jw q60J3
(317)81�-*372
EFT DEBIT pURCxoSE 03/26/13 10. 13 AM
08 CoKO % XKKyX�KXKX-Xk8019
TOTAL T8nwSnCrI0w nmOUwr 7.69
REF:311623
______ ---
_____ _______
vp DEBIT r.69
. Cxows[ .00
TOTAL NUMBER OF I)EM3 SOLD ~ 4
3/26/13 10:13 8H 0206 OJ 0018 163
YOUR CASHIER WAS MeRGE
'
THANK YOU oFOR SHOPPING
0 / MA To
CHECK U3 OUT: http'//www.omallmo.cvn
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$31.66
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 Classic Spirits 42-390.40 j $23.97 1 hereby certify that the attached invoice(s), or
1207 O'Malia 42-390.40 $7.69 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
Wednesday, March 27, 2013
Director, Brooks Ire Golf Club
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))
03/25/13 Classic Spirits Mixers $23.97
03/26/13 I O'Malia I Food $7.69
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
ENTENNANNS PAl,'-'ERY
5016 Er' 62W) ST
1NDIANAPM15 IN
2,2 1"P*! P,!*"R 3/13
00-7507 002 DIANA
01087 .
950400739554
Moo @ $1 M
OUT ILL!: LINEM3.27
SL 20OZ 5900.99
BB 240Z jl�i$1.49
M. 10 1) . '?5 -
CASH 0.-()0
CHANGE 4.2-5
THANKS FOR SHOPPING
AT ENTENMANNS BAKERY
OUTLET STORES
t
CLASSIC SPIRITS
12588 GRAY RD
CARMEL, IN 46033
0326/2013 11:37:00
Merchant ID: 000000000648551
Terminal ID: 00924067
231560632888
CREDIT CARD
VISA SALE
CARD# XXXXXXXXXXXX0376
INVOICE 0004
Batch#: 001845
Approval Code: 000054
Entry Method: Swiped
Approved: Online
SALE AMOUNT $25.65
CUSTOMER COPY
meojer
1424 West Carmel Dr.
Carmel, IN 46032-#130
i3'17j573-8300 meijei.com
The Meijer Team appreciates your business
04/04/13
Your fast and friendly checkout was
provided by KALA
K---SAVINGS TODAY-i—c—
TOTAL NON-COUPON SAVINGS 3.33 --
-SAVINGS TOTAL 3 . 33-
GROCERY
4061 LETTUCE .99 F
4082 MOM RED ONION 1.71 F
1.15 lb @ 1 lb / 1.49
*70882014036 TOMATOES
was 2.69 now 1.33 F
1.37 lb ® I- lb / - .97
0131400598 BUNS
3 ® 3 / 5.00
was 5.97 now 5.00 N
TOTAL
TOTAL TAX .00
TOTAL 9.03
PAYMENTS
CASH TENDER 9.25
CASH CHANGE .22
NUMBER OF ITEMS 6
See meijer.com or the Service Desk for
current return policy.
For additional savings and details visit
mPerks.Meijer.com.
IIII III III IIIIIIII VIII III I IIIIIIII I I I I IIIIIIII
A013004PSF2X355
Tx:47 Op:2039655 Tm:22 St:130 13:53:45
I LUI 1101 IVl QI1&U1 [VI IO UI 11 k"MI MIS u
limited to):alcohol,tobacco,ammunition,prepaid
cards,and open collector sports cards or blood
glucose monitors.
Meijer reserves the rightto restrict or refuse returns.
Full Return Policy is available at Meijer.com.
Return Policy
Returns are subject to lowest sale or promotional
pricing,including bundled offers,and will be refunded
in the original purchase tender type. Returns without
receipt may require a valid ID and will be issued a
rvieijer Merchandise Return Card forthe refund value.
Meijer stands behind our name;any productwith the
"Meijer"brand may be returned with orwithout a
receipt,provided it is not a state-approved WIC item.
We will provide a full refund for all non-WIC approved
food items with or without a receipt. For WIC
approved food items we will provide a refund if you
have a receiptthat shows the item was not purchased
in a WIC transaction. Meijer cannot provide refunds
forfood items,including produce and formula,which
may have been purchased with WIC.
Meijerwill honor General Merchandise refunds and
exchanges within 90 days of purchase. Returns of
electronic items,media and items powered by
flammable liquid or gas must be made within 30
days. Returns of open electronic items,media and
items powered by flammable liquids or gas are
subjectto additional fees,restrictions or refusal.
Items not eligible for return include(but are not
limited to):alcohol,tobacco,ammunition,prepaid
cards,and open collector sports cards or blood
glucose monitors.
Meijer reserves the right to restrict or refuse returns.
Full Return Policy is available at Meijer.com.
Return Policy
Returns are subject to lowest sale or promotional
pricing,including bundled offers,and will be refunded
WMALIA #206
4755 E. 126TH ST.
CARMEL, IN 46033
(317')844--43 1:2
CUSTOMER NUIIB*--R 40020008370
18 MONI'GIMERY BBQ PC 2.69 F
SC 1165 MONTGOMERY BBQ 1 .36-F
TAX .00 BAL 1 .33
CASH 1 .33
CHA1\113= 00
TOTAL NUMBER OF ITEMS SOLD = 1
4/04/13 1: 33 PM 0206 03 0147 163
YOUR CASHIER WAS MARGE
YOU S 0 V D
$ '1 . 36 C 51
ON YOUR ORDER TODAY
YOUR SAVINGS
COUPON PLUS SAVINGS 1 ,36
TOTAL SAVINGS. (51%) S 1 .36 .
YOUR SAVINGS
THANK YOU FOR SHOPPING
WMALIPi
CHECK US OUT: h,ttp://www.omalias.com
With your Marsh Fresh Idea Card
You saved
S124.39 in 2012.
You have saved
$37.115 in 2013.
Marsh Fresh IDEA Card
required For all offers.
Thank You for Shopping
Marsh!
0 ' III Pi L lIII #x.016
4755 E. 126TH ST.
CARMI:::L, IN 46033
( 3 F?)84,1-1372
25;' AM BUN HKi!! Cl— KSR PC 3.39 F
CUSTOMER NEIMBL`-Et 40020008370
SC 711 AM :BUN IiRTH CL KSR 1 .39—F
38711 KRF r OE IG BE!W SCE PC 1 .69 F
SC 1001 KRI='I CII,,'IG BBQ SCE .19—F
**3 TAX .00 BAL 3.50
CASH 3.50
CHANGE. .00
TOTAL NUMBER iiF IEEMS SOLD = 2
4/05/13 9: 22 AM 0206 01 0026 101
YOUR Cl;':'HIER W11S THERESA
1 OlU SAVED
$ 1 . 58 ( 31y, )
ON YOUR ORDFIR TODAY
YI:IIJR SAVINGS ***+******
COUPON PLU'S SAVINGS 1 .58
TOTEIL SAVINEii'i (31%) S 1 .58
****;i;***at* 'YI:IIJR SAVINGS
THANK Y131tJ Fl31'-} SHOPPING
CHECK EIS OUT: http://www.oma[ias.com
With WoLr Marsh Fr,,:-;h Idea Card
You saved
:612,1.89 in 2012.
You have saved
$39-03 in 2013.
March Fresh ILA Card
renurrEC for alJ offers.
Thank :nu for ShOPF'irii3
Mi_irsh!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$19.61
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 Entenmanns 42-390.40 $5.75 1 hereby certify that the attached invoice(s), or
1207 Meijer 42-390.40 $9.03 bill(s) is (are) true and correct and that the
1207 O'Malia 42-390.40 $1.33
materials or services itemized thereon for
1207 O'Malia 42-390.40 $3.50
which charge is made were ordered and
received except
r Friday, April 05, 2013
1
Director, Brook ire Golf Club
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))
04/03/13 Entenmanns Bread $5.75
04/04/13 Meijer Food $9.03
04/04/13 O'Malia Food $1.33
04/05/13 I O'Malia I Food $3.50
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
120
Clerk-Treasurer