219002 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 00350579 Page 1 of 1
Q� ONE CIVIC SQUARE R&T AUTO SUPPLY, INC CHECK AMOUNT: $275.76
CARMEL, INDIANA 46032 516 S MAIN ST
SHERIDAN IN 46069 CHECK NUMBER: 219002
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 5802-92318 275 . 76 TIRES & TUBES
CARQUEST
m R & T AUTO SUPPLY , INC PAGE 1
516 S MAIN STREET REF# 97635
AUTO PARTS SHERIDAN, IN 46069
(317 ) 758-4456
SERVING A WORLD IN MOTION ! ! !
5802-92318 2070
ANY PART RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT SEE oARuUEm STORE FOR DETAILS or THIS COAST m COAST GUARANTEE.
OF CARMEL TY OF CARME
W 131ST OO W 131ST
�ARMEL, IN 46O74 | CARMEL, IN 460
.- �� [�
58O2-92318 20 70 3/26/2O1 '
114.48 N
WARRANTY DISCLAIMER:Th.mrwfacturers y, nstitLnw the oay�ZTara ith resgectp the safe of all goods.SELLER HEREBY EXPRESSLY DISCLAIMS ALL WARRANTIES,EITH R EXPRESSED OR IMPLIED,
INCLUDINGANY IMPU ED WARRANTY OF MERC I I FITNESS FOR A TIC L�R PUR OS Seller does not authortze any person to grant any_rmty or assurne my llabillty by Seller.
PAY THIS
Customer Name
Customer Phone ##
Customer Mailing Add'res's
Original Cash Sale,Invoic e #
Customer's Signature
Counterpro's Signature
Counterpro's #
Manager's Initials
This is a compam policy to help verify cash refunds and thus safeguard our assets.
VOUCHER NO. WARRANT NO.
ALLOWED 20
R & T Auto Supply
IN SUM OF $
516 S. Main Street
Sheridan, IN 46069
$275.76
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT_ Board Members
2201 I 5802-92318 I 42-320.001 $275.76 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
� edne� y, h 27-2013
d44 Qd4
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))
03/26/13 5802-92318 $275.76
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