223861 09/10/2013 „M CITY OF CARMEL, INDIANA VENDOR: 367001 Page 1 of 1
ONE CIVIC SQUARE CAPITAL ONE COMMERCIAL CHECK AMOUNT: $85.65
CARMEL, INDIANA 46032 PO Box 5219
CAROL STREAM IL 60197-5219 CHECK NUMBER: 223861
CHECK DATE: 9/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4235000 049380 85 . 65 BUILDING MATERIAL
Please Direct Inquiries To:1-800-220-8594 cosycol COSTCO
EMMillIMESALE
A New::Balance.�.... Pov Me Date,
.......... ......
. .......... .... .. . ....
':7003.73 $85 65: . . .....
� 11.0007.4.683 .....V �d _
00.
............. ........ .09/4/20.13..
..... . .. ....
..... . .. . . . . AvailabI6 Credit
.. . ..........
Billing Date:
. ............ ..
.................. .. . . .......
.. . 08/26/2012
. O . $1:914 35:
TDID/Hearing Impaired: 1-B00-365-0186
STATEMENT OF YOUR ACCOUNT
.............. .......................
.................. .............................................
...... ........
'6 NN M-CHARGESUMMARY. : ...........
....................
...........
U Credit Credit Average Daily Corres- FINANCE ANNUAL New NOnimum Promo
C� Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
�2
0
I? Reg 00014 $5.53 0.00000% 00.00% $.00 00.00% 585.65 $.00 09/26/2013
ACCOUNT DETAIL
. . . . . ... . . . . . ... . . . .
Transaction...
.7
.................... P;Q...........
.... . ..... ................... .. ............ ....... .......... ................
..... ............
. . ........
...........��:':
N ber;K.%:%i:i:,1 .%4D:: ouht:l. �i-
M
............. .......... ...... .......
07/29/2013 COSTCO WHOLESALE-347 049380 00003 $85.65
00003 SUBTOTAL: $85.65
Your account information is in your control when you register securely at www.hrscommemial.com
Return the below portion with payment.For billing•eriors or questions please refer to the back of the stalament. Page 1 of 2
Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized
purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement
will be presumed to be correct.
Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160.
You may telephone Capital One Commercial at 1-800-210-8115,but it will not preserve your rights.
Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user.
CbSTC0. COSTCO
ACCOUNT SUMMARY BALANCE SUMMARY
Outstanding
....................... ....... . Transaction $.00
:-DAYS.PilM. T:DUE:': 3M9.,:DAY.-9.PASt--.:*
............
.............. ....... .........
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $85.65
...............--. .........
........-- ........................ +New Fees $.00
.—....6.0....-.6..9..A)AYSP..AS..TO E WIDAW.. PAST
:D
UE 120ri 49 DAYSPAST DUE-
+Finance Charges $.00
$.00 $.00 $.00 Payment(s) $.00
70ZAYS:PAST
Credits) $.00
$.00 $.00 New Balance
0 $85.65
C,
C?
Page 2 of 2
--------------------- -
1:1 F1 111:1.0 1:1
Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized
purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement
will be presumed to be correct.
Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160.
You may telephone Capital One Commercial at 1-800-210-8115, but it will not preserve your rights.
Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user.
22CAP720298(02/13)
TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS
AND NUMBERS ONLY!
M aIa❑❑❑❑❑❑❑❑❑L ❑❑❑❑❑❑❑❑❑❑❑❑❑❑
Email Address
❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑
Street Number if anv, ❑❑ Street Name or the words"PO BOX" Unit or PO BOX Number
HHF IH❑L_1LJ ❑❑❑❑❑❑❑❑❑❑❑ ❑❑❑❑❑
Ci�❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ state❑❑ ZM❑❑❑❑
Business Phone
❑❑❑/❑❑❑-❑❑❑❑ i
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 049380 Cleaning Supplies $85.65
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Capital One Commercial
IN SUM OF $
P.O. Box 5219
Carol Stream, IL 60197-5219
$85.65
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE i AMOUNT Board Members
1207 I 049380 I 42-350.00 I $85.65 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
Monday, September 09, 2013
Director, Brookshire f Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund