221348 06/26/2013 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC CHECK AMOUNT: $173.60
,? CARMEL, INDIANA 46032 PO BOX 2856
KOKOMO IN 46904-2856 CHECK NUMBER: 221348
CHECK DATE: 6/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 173 . 60 FOOD & BEVERAGES
MIWAMER1CA INVOICE
BEVERAGE f P' CITY OF -CARMEL .
'NC■ dba BR00KSHIRE GOLF CLUB
y�
12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. , CARMEL IN 46032,
P.O. Box 2856
Kokomo, IN 469042856 RR2903542 EXP. 07/13/14
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE ', INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
06f27/13 526193 Dustin Smith 13 800 13
•.
BASE October 7, 2012
PROMO #0613
Wine: W342887
Pump $45/$40 Refundable
109 6� Budweiser 24 Lse Can 17.80 106.80
209 2. , Bud Lt 24 Lse Can 17.80 35.60
408 2''A '' B Lt Lime 2/12 Can 21 . 10 42.20
^ L
i
D
Cases 10
- - TOTAL SALE 184.60
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 1/2 30.00 H
10405 EMPTY AB 1/4 30.00 5Q,as
9230 PUMP,DEPOSIT 33.00 N
9270 IMPORT PUMP DEPOSIT 33.00 K
184.60
if
® CREDITS
0 Cash ❑ EFT ❑ Escrow Check Number gg;z // ,
Driver river Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856 -
Kokomo, IN 46904-2856
$1,555.60
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 526193 42-390.40 j $154.60 1 hereby certify that the attached invoice(s), or
1207 528074 42-390.40 1 $1,026.20 bill(s) is (are) true and correct and that the
1207 529013 42-390.40 $78.00
materials or services itemized thereon for
1207 529515 42-390.40 $296.80
which charge is made were ordered and
received except
Thursday, July 25, 2013
Director, Brooksh olf 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))
06/27/13 526193 Beer $154.60
07/11/13 528074 Beer $1,026.20
07/19/13 529013 Beer $78.00
07/25/13 529515 Beer $296.80
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
20
Clerk-Treasurer