222976 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS CHECK AMOUNT: $221.78
CARMEL, INDIANA 46032 PO BOX 877
'4,ion t� BELMONT MS 38827 CHECK NUMBER: 222976
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0118970-IN 221 . 78 UNIFORMS
O �E PAGE: 1
HALSEiV PRODUCTS COMPANY O C7
P.O.BOX 877
BELMONT,MS 38827
NATIONWIDE 1-800-344-6696 INVOICE NUMBER:
FAX 1-800-826-8839
INVOICE DATE: 7/29/2013
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0-523
CUSTOMER NO: 02303.27
SOLD TO SHIP TO
CITY- OF CARMEL STREET DEr'AP.TMENT
ATTENTION ACCOUNT'S D YABLE NI,Y L U N N
3400 W 131ST ST 3400 WEST 13"1 'STREET
CARREL, IN 46074 CARMEL, IN 46074
CONFIRM TO:
AMY
_. CUSTOMER PQ; SHIP VIA TERMS _
AMY UPS
Net 30
ITEMrNO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
„_TNt )=K EACH 288 288 0 0 . 700 201.60
BROWN JERSEY GLOVE
Net Invoice: 201.60
THANK YOU FOR "YOUR. ORDER ! !
Freight: 20.18
Sales Ta. 0. 00
Invoice Total: 221. 78
Less Deposit: 0. 00
221.78
IfdVO10E BALANCE
VOUCHER NO. WARRANT NO.
Halsen Products ALLOWED 20
IN SUM OF $
P. O. Box 877
Belmont, MS 38827
$221.78
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 0118970-IN I 43-560.01 I $221.78 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
° rid ,! u us 0 2013
ei 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))
07/29/13 0118970-IN $221.78
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