221194 06/18/2013 °�. CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH-BROOKSHIRE GOLF COT�g
: CARMEL, INDIANA 46032 C/O PAM LISTER CHECK AMOUNT: $151.38
CHECK NUMBER: 221194
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 35916 151 . 38 EQUIPMENT REPAIRS & M
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:vrYZ :a 3 O ' PIALIA #206
4.755 E. 126TH ST.
CARMEL, IN 46033
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4088 FOAM ::UPS 69 T
9088 FOAM :;UPS 2. 6`.3 T
x TAX 38 BAL 76
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CASH 20.00
CHA1413 11 ,211
TOTAL NUMBER JF JTEMS SOLD = 2
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6/1 1/13 10 57 Arl 0205 03 0043 10
YOUR ASHIER WAS MARGE
THANK YOU FOR SHOPPI:NO
CHECK US OU'T; http://www.omalia;s.com
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DON'S GARAGE
16995 Cherry Tree Ave. N�• 35016
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Noblesville, IN 46060
(317) 773-4597
Fax (317) 774-1860
SOLD TO
CASH DEPT.
STREET
CHARGE C.O.D. MDSE.'RETURNED
CITY
DATE ) SALESMAN ORDER NO. TERMS VIA
ORDERED ORDERED SHIPPED NUMBER'' ITEM DESCRIPTION LIST NET AMOUNT
I C9rl
032 �.r /� �_ 6 CG
I i
I
C
TAX
ALL CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL
TOTAL 77''
RECEIVED BY
NOTICE - AFTER 30 DAYS
FINANCE CHARGE IS COMPUTED BY A PERIODIC RATE OF I V2% PER MONTHLY BILLING CYCLE WHICH IS AN ANNUAL
PERCENTAGE RATE OF 18% APPLIED TO THE PREVIOUS BALANCE AFTER DEDUCTING ALL PAYMENTS AND CREDITS DUR-
ING BILLING CYCLE.
TO AVOID FINANCE CHARGES, PAY THIS ACCOUNT WITHIN 30 DAYS FROM
MINIMUM FINANCE CHARGE .50 CENTS
■
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))
06/11/13 35916 Repair Parts $146.00
06/11/13 Omalia Cups $5.38
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
Petty Cash
IN SUM OF $
$151.38
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 35916 43-500.00 $146.00 1 hereby certify that the attached invoice(s), or
1207 Omalia 43-500.00 $5.38 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
Monday, June 17, 2013
1
Director, Brooks W e Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund