222119 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH-BROOKSHIRE GOLF CO
{ CARMEL, INDIANA 46032 CIO PAM LISTER CK AMOUNT: $27.56
CHECK NUMBER: 222119
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 27 . 56 FOOD & BEVERAGES
cosyco
##3-16 Cf-ISTI�ETON , IN
6'110 EAST ;8'T11 ST°EET
CASTLETON,' IN 46250
MEMBER #1,11750046398
E 904849 HOT DOG BUN 2.79
E 904849 HOT DOG BUN 2.79
E 904849 HOT DOG BUN 2.79
E 904856 HAMBURG BUN 2.69
TOTAL
VF EFT/--7-T 11 .06
XXXXXXXXXXXY SWIPED
07/06/13 15:54 PIN USED
SP.-4#: 002123 APP#: '828225
EFT/DEBIT ResP: AA
Tran ID#: 318717075000
Merchant ID 99034611
APPROVED - PURCHASE
AMOUNT: $11 .06
0346 202 0000000202 0220
---------------------------------------
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD = 4
CASHIER: SCO LANE #202 REG# 202
! /LtL�f!i�11K 15:54 0346202 0220 202
PLEASE COME_ AGOIN !
THANK YOU
*For Using COSTCO*
Self Checkout #
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11'0917 N K AW 8V3
AS H.1.9Z K "I SiCi L
W MALTA #206
4755 E. 126TH ST.
CARMEL, IN 46033
(317)844-4372
255 MARSH BUN SEEDED PC 1 .19 F
255 MARSH BUN SEEDED PC 1 .49 F
CUSTOMER NUMBER 98317367313
SC 2666 MARSH BUN SEEDED .49-F
SC 2666 MARSH BUN SEEDED .49-F
TAX .00 BAL 2.00
CASH 2.00
CHANGE .00
TOTAL NUMBER OF ITEMS SOLD = 2
7/06/13 9:42 PM 0206 06 0151 132
YOUR CASHIER WA; ULIVTA
YOU SAVED
$ . 98 ( 33% )
ON YOUR ORDER TODAY
**** YOUR SAVINGS *********M
COUPON PLUS SAVINGS .98
TOTAL SAVINGS (33x) 3 .98
********** YOUR SAVINGS
THANK YOU FOR SHOPPING
O ' MALIA
CHECK US OUT: http://www.omallas.com
Witn w—r Marsh Fresh Idea Card
You saved
$168.30 in 2012.
You have saved
$71 .73 in 2013.
Marsh Fresh IDEA Card
required for all offers.
Thank you for Shopping
Marsh!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$27.56
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#(TITLE AMOUNT Board Members
1207 O'Malia 42-390.40 $2.00 1 hereby certify that the attached invoice(s), or
1207 Costco 42-390.40 $11.06 bill(s) is (are)true and correct and that the
1207 Entenmanns 42-390.40 $10.50
materials or services itemized thereon for
1207 O'Malia 42-390.40 $4.00
which charge is made were ordered and
received except
Monday, July 08, 2013
Director, Broo ire 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))
07/06/13 O'Malia Bread I $2.00
07/06/13 Costco Bread $11.06
07/06/13 Entenmanns Bread $10.50
07/08/13 O'Malia Bread I $4.00
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
120
Clerk-Treasurer