219763 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 00352767 Page 1 of 1 SQUARE ONE CIVICINDI NA 46032 WILLIAM HOHLT CHECK AMOUNT: $76.99
C/ODOCs
CHECK NUMBER: 219763
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4351000 656296 68 . 99 AUTO REPAIR & MAINTEN
1192 4351100 656296 8 . 00 CAR CLEANING
Au FoZone 2622
1445 S RANGE LI
CARMEL, IN
(317) 843-9705
VDP PART 1 @ 1/68.99
VDP PARTS PO # 020753
4071259 FOR194100L 68.99 P
FDR194100L Pilot
Non-Heated Power Mirror, EA
TAX EXEMPT TRANSACTION
STATE TAX # 0003130155
CARMEL FIRE
SUBTOTAL 68.99
TOTAL 68.99 Enter to Win $5001
for
CASH 80,00 visit mikesca urva
rulaa
CHANGE 1 1 ,O1 -uaa Sala 4 155 7 4 57 551-
REG #02 CSR #05 RECEIPT #906985 Mike`s Carmel
1250 Ranye line Road
S-TR . I-RµAN:S} :#656296 317-511-1929
5 T O ih R E 2 6 2 2 029PTT4
DATE 09/26/201 3 14:20 E5pl 42013, 02:25 P4- 14616 1
Empl 4451_'., Sale tl 915574fi7fi51
a.00
_sxeftESS -
It O F T T E M S S O L D 1 ----_
gubtotal 8.00
Hales Tax 0.00
Total 8.00
8,00
I I _
ca. _
#'0 8 A
*2622656296042613X ra,
ShiPPir-l9 Is N(D+ v
Ref undab Y e
VDP PARTS PO # : 020753
EST. ARRIVE DATE: 04/30/2013
EST, ARRIVE TIME: 3:00 PM
CARRIER FEDEX
I
Take a survey for a
cFlance +CD. w i n $l 0000
at www.autozonecat-es.com
or by calling 1-800-598-8943.
No Purchase necessary. Ends 05/31/13, C1
Sub.iect to full official rules G
at www.autozonecares,com
Ref No
2622-656296-130426-3
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))
04/26/13 656296 Power Mirror $68.99
05/01/13 Car Wash $8.00
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.
William Hohlt ALLOWED 20
IN SUM OF $
c/o One Civic Square
Carmel, IN 46032
$76.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1192 656296 43-510.00 $68.99 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1192 43-511.00 $8.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Mond y, May 06 013
Directo
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund