219141 04/16/2013 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: $354.20
t� KOKOMO IN 46904-2856
CHECK NUMBER: 219141
CHECK DATE: 4116/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 354 . 20 FOOD & BEVERAGES
MIDAMERICA INVOICE
BEWRACE CITY OF CARMEL
'NC■ dba BROOKSHIRE GOLF CLUB
.12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
Kokomo, IN 46904-2856 RR2903542 EXP. 07/13/13
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
04/18/13 517639 Dustin Smith 13 B00 13
PR6DbCT LINT
•.
DESCRIPTION PRICE— AMO
BASE October 7., 2012
PROMO #0413
WINE: W3428870
Mid America Beverage Inc
109 5 -''- Budweiser 24 Lse Can 17.80 89.00
209 5 --- Bud Lt 24 Lse Can 17.80 89.0.0;
408 2 Bud Lt Lime 2/12 Can 21 . 10 t.` 42.20
1537 2 — Stella 2/10 Pack 14.9 oz 24.00 48.00
760 1 Goose 312 1/6 BBL 56.00 30.00 86.00
Cases 14 1/4 Barrels 1
TOTAL SALE 354.20
10303 EMPTY AB 1/6 30.00 T
10304. EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00 N
9270 IMPORT PUMP DEPOSIT 33.00 K
354.20
anmI D ® CREDITS
❑ Cash ❑ EFT ❑ Escrow 1 Check Number 2 ! ��/ • ® "7 r f
r
Driver /i Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$354.20
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1207 I 517639 I 42-390.40 I $354.20 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
Thursday, April 18, 2013
Director, Bro shire 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))
04/18/13 517639 Beer $354.20
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