218737 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
° ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CARMEL, INDIANA 46032 PO Box 2856 CHECK AMOUNT: $184.80
KOKOMO IN 46904-2856
CHECK NUMBER: 218737
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 184 . 80 FOOD & BEVERAGES
MIWAMERICA f INVOICE
BEVERAGE
CITY OF, CARMEL
d ba BROdiCSN'IRE'GOLF `CLt113 "
'NC■ t` , 12120 BROOKSH I RE PARKWAY
2755 Commerce Dr. CARMEL IN - 46032
P.O. Box 2856,,�,,;
Kokomo, *46964-2856 p� L A i'-. 077.1.3/125
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
04/11/13 516570 Dustin Smith 13 800 13
-TO
BASE October 7, 2012
PROMO # 0413
WINE: W3428870
Mid America Beverage Inc
209 6 " Bud Lt. 24 Lse Can 17.80 106.80
225 1 r Bud Lt 1/4 BBL 48.00 30.00 78.00
. i
Cases 6 1/4 Barrels 1
r .
• ° - TOTAL SALE 164.80'
10303 EMPTY AB 1/6 a ._ 30.00 T
10304, EMPTY AB"1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMRDEPOSIT 33.00 N t
9270 IMPORT PUMP DEPOSIT 33.00 K
184.80
s • , °
2 ® CREDITS
❑ Cash ❑ EFT ❑ Escrow / Check Number
Driver ��� v Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$184.80
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 516570 I 42-390.40 I $184.80 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
Thursday, April 11, 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))
04/11/13 I 516570 I Beer I $184.80
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