224828 10/08/2013 „yf CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC CHECK AMOUNT: $51.00
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD
CARMEL IN 46032
CHECK NUMBER: 224828
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 139840 51 . 00 AUTO REPAIR & MAINTEN
i 622 eline Road
C S. Ran g
"YOU ARE RIDING ON OUR REPUTATION" LARK Carmel, IN 46032
4w I (317) 844-4839
RE
Q1N t t matio al PENS IL
I,THE UNDERSIGNED,HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE
A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID.I FURTHER AGREE TI[AT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE,AND
IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING
AGENCY AND ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BY LAWS GOVERNING TI[ESE TRANSACTIONS.
A finance charge of 13/4%Per Month will be charged on all Accounts 30 days Past Due.Annual Percentage Rate is 21%.(Minimum 75) RECEIVED BY
SOLD TOtffla FIRE DEPT. 5900f01 SHIP T%E INVOICE# 139840
TWO CIVIC SGUARE
CARMEL IN 46032
CUST.P.O.# MAKE-MODEL ID# MILEAGE JVLI tt&NE ROUTE SLM SHIP VIA ORDER# PAGE REMARKS
#47 #47 205606 571-2609 0 5 N/A 1572391 1
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER Opened by Operator
10/02/2013 139840 NET 10TH 10/02/13 14:00:46 8
STOCK NUMBER SIZE DESCRIPTION QUANTITY ORDERS T F.E.T. EXTENSION
ORDERS SHIPPED PREV.SHIP PRICE
PASS REAR AND FRONT
16 160 DISMOUNT 9 NOW PASSENGER 2 2 16.00 .00 32.00
REPO EACH INSIDE REPAIR ON VEHICLE 2 2 9.50 .00 19.00
METHOD OF PAYMENT:
CHARGE: 51.00
CHANGE: .00
.k
ank you for your business a oug K
PARTS LABOR TAX°h1 TM BLE TAX F.E.T. AnMnoUNT V .I
51.00 001120155—W-0 51.00
"You're Riding On Our Reputation"
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))
139840 9184 $51.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire
IN SUM OF $
622 South Rangeline Road
Carmel, IN 46032
$51.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1120 I 139840 I 43-510.00 I $51.00 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
OCT w 209
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund