219829 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 355473 Page 1 of 1
ONE CIVIC SQUARE DAREN MINDHAM
e' CARMEL, INDIANA 46032 221 CORRAL COURT CHECK AMOUNT: $139.99
FISHERS IN 46038
CHECK NUMBER: 219829
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4239012 139 . 99 SAFETY SUPPLIES
DICK ' S SPORTING GOODS
Indianapolis, IN
(317) 576-0300
05/05/13 11:47 AM .
RECEIPT EXPIRES ON 08/03/13
5-00416 R-6 T-3149 A-0110681SALE
Your aSSOC.i ate today/ i s Are 1 i s
F-
-1-A>< EXEMP* `=SAL
Customer Copy
773984980285 GEOMORPHBL/B 139.99 N
ITEM TOTAL 139.99
SUBTOTAL. - . . 139.99
TOTAL 1.39.99
TAX EXEMPT 4001201550
CASH 140.00
CHANGE DUE 0.01
CITY OF CARMEL
(317) 796-0329
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Daren Mindham
i IN SUM OF $
c/o One Civic Square
Carmel, IN 46032
$139.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1192 I I 42-390.12 I $139.99 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
Mond , Mai 06 13
f
Director
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))
05/05/13 Boots $139.99
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