224037 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
:L ONE CIVIC SQUARE MID AMERICA BEVERAGE INC CHECK AMOUNT: $292.80
CARMEL, INDIANA 46032 PO BOX 2856
s�ao KOKOMO IN 46904-2856 CHECK NUMBER: 224037
CHECK DATE: 9/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 292 . 80 FOOD & BEVERAGES
MIWAMERICA INVOICE
CITY OF CARME
BEVERAGE , L
dba BROOK SH IRE GOLF 'CL OB`
INC■ 12120 BROOKSHIRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032 ,
P.O. Box 2856
Kokomo, IN 46904-2856 RR2703342 EXP. 071 y
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
09/12/13 535463 Dustin Smith 13 800 13
DESCRIPTION- I AMOUNT.
PR CE DEPOSIT.
YRODUCT QUANTITY.
•o
BASE October 7 2012
PROMO #0913A
Wine: W342887
Pump $52/$47 Refundable
209 4 ,-- Bud Lt 24 Lye Can 17.80 71 .20
408 2.--- B Lt Lime 2/12 Can 21 . 10 42.20
909 3 Mich Ultra 24 Lse Can 19.30 57.90
1537 3 '" Stella 2/10 Pack 14.9 oz 24.00 72.00
7025 2 Goose 312 2/12 Can 24. 75 49.50 :
r- f
tai F .2s
_Fy.
Cases 14
• • 911jol TOTAL SALE 292.80
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY A13,1/2 30.00 H
10405 EMPTY AB 1/4 30.00 A
9230 PUMP DEPOSIT 33.00 N
9270 IMPORT PUMP DEPOSIT 33.00 K
292.80
® CREDITS
❑ Cash ❑ EFT ❑ Escrow C heck Number Z�K'G
/011
Driver �� _ Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$292.80
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
1207 I 535463 I 42-390.40 I $292.80 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, September 12, 2013
Director, BrooksNirVGolf 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))
09/12/13 535463 Beer $292.80
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