218790 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 367001 Page 1 of 1
` ONE CIVIC SQUARE CAPITAL ONE COMMERCIAL CHECK AMOUNT: $94.55
CARMEL, INDIANA 46032 PO BOX 5219
CAROL STREAM IL 60197-5219 CHECK NUMBER: 218790
CHECK DATE: 4/912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 GOLF COSTCO 24 . 78 7003-7311-0007-4683
1207 4350100 GOLF COSTCO 69 . 77 7003-7311-0007-4683
Please Direct Inquiries To: 1-800-220-8594 cbsyco. COSTCO
WItaOLES�ALE
Account Number New Balance Payment Due Amount Past;.Due Due:Date
7003J311:0007 4683 $94 55 $.00 $00:., 04/20/2013
Btllmg!Date Credit Line Available Gredtt
03/26i2p13 $2 OQO $1 905 45
TDD/Nearing Impaired: 1-800-365-0186
STATEMENT OF YOUR ACCOUNT
0
05 FINANCE'CHARG,E$IJINMARY -.i:
_,.
.
0
Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
a Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Q
Description Number Balance Rate APR Periodic Rate RATE Due
/0.
.
Reg Re 00014 $675 000000
o ° 00.00%° $.00 00.00% 594.55 $.00 04/26/2013
0
0
0
ACCOUNT DETAIL
a
Transacion Transaction
Invoke User P,O TranSaCtlpn
Date Dt3scripdton Number ID'; Number Amount;
..
03/12/2013 COSTCO WHOLESALE-346 065750 00003 $94.55
00003 SUBTOTAL: $94.55
Manage your account anytime!Secure registration at www.hrscommercial.com
Return the below portion with payment.For billing errors or questions please refer to the back of the statement. Page 1 of 2
cbsrcol COSTCO
ACCOUNT SUMMARY BALANCE SUMMARY
utstan in
CURREN ........ 129 DAYS f!AST Dkl£
30 59 DAYS PAST DUE Transaction $.00
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $94.55
.
... +New Fees .00
60-$9 DA.YS RAST DUE 90 1 1.9 QAYS:PAST 31�E 12Q 149 PAYS PAST C3LiE;
+Finance Charges $.00
$.00 $.00 $.00
Payment(s) $.00
..............._..................................._......................................................................................._...._............ ......
150 179_DAYS:PAST D E 180+DAYS:PAST DU.E Credit(s) $.00
0
$.00 $.00 =New Balance $94.55
COSTCO
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#346 CASTLETON , IN
6110 EAST 86 STREET
CASTLETON, IN 46250
MEMBER 1791434655
RESALE ON
25313 *MTHNHDBATH* 45.99
221670 **KV/TISSUE* 14.79
617686 SOFJSOAP 8.99
E 649576 FRIJOkAY54CT 12..,39
E 649576 FRITOURY5iCT 12.39
RESALE TOTAL 94.55
NON RESALE TOTAL .00
TOTA Page 2 of 2
L j�:�-g�
-------------
--------- VF Costco Wholesale 94.55 --- ------ - ---- ----------
------------ -------------------------
XXXXXXXXXXXX0683 SWIPED
03/12/13 13:4,4
Se9#: 004204 APP#: 065750
Costco Wholesale ResP: AA
Tran ID#: 3071069880.00'
Merchant ID 99034611
APPROVED - PURCHASE
AMOUNT: $94.55
0346 011 0000000021 0021
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD = 5
CASHIER: DAVID R. REG# 11
IM MAP-441K 13:44 0346 11 0021 21
THANK YOU !
PLEASE COME AGAIN !
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 065750 Chips $24.78
03/26/13 065750 Building Maintenance $69.77
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Capital One Commercial
IN SUM OF $
P.O. Box 5219
Carol Stream, IL 60197-5219
$94.55
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 065750 42-390.40 $24.78 1 hereby certify that the attached invoice(s), or
1207 065750 'Xj s-(-I/,OD $69.77 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