221321 06/19/2013 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: $369.90
KOKOMOIN 46904-2856 CHECK NUMBER: 221321
CHECK DATE: 6/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 GOLF 369 . 90 FOOD & BEVERAGES
MIMA AERICA INVOICE
BEVERAGE- CITY OF .CARMEL
w dba BROOKSHIRE GOLF CLUB
INC.
12120 BROOKSHIRE PARKWAY
g 2755 Commerce Dr. CARMEL IN 46032
" P.O. Box 2856
Kokomo, IN 46904-2856
765-459-3117 RR2903542 EXP. 07/13/1,5
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
06/20/13 525459 Dustin Smith 13 800 13
Rb
• DESCRIPTION DEPOSIT
AMOUNT
•.
BASE October 7, 2012
PROMO #0613
Wine: W342887
Pump $45/$40 Refundable
109 6 Budweiser 24 Lse Can 17.80 106.80
209 12 Bud Lt 24 Lse Can 17.80 213.60
7025 2 Goose 312 2/12 Can 24.75 49,50
•.zc.
Cases 20
••• •• • • • •
TOTAL SALE 369.90
10303 I'' EMPTY AB 1/6 30.00
10304 i' 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
369.90
® CREDITS
❑ Cash ❑ EFT ❑ Escrow Check Number /%% �� U ® A
r
i 90
Driver 4o_�' Received By
d r
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))
06/20/13 525459 Beer $369.90
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
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$369.90
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 525459 I 42-390.40 I $369.90 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, June 20, 2013
Director, Brookshir olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund