224910 10/08/2013 "a CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $219.47
„o �o
BELMONT MS 38827 CHECK NUMBER: 224910
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0119460—IN 219 .47 UNIFORMS
PAGE:LI U Cl V 1
HALSEN PRODUCTS COMPANY ®�LJ L�
P.O.BOX 877
BELMONT,MS 38827
NATIONWIDE 1-800-344-6696
FAX 1 000026 0839 INVOICE NUMBER: 94 60-IN
INVOICE DATE: 9/30/2013
ORDER NUMBER:
ORDER DATE:
SALESPERSON: U 5 23
CUSTOMER NO: 022;.0327
SOLD TO SHIP TO
(_TTY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE AMY LUNN
3400 W 131ST ST 3400 VEST 131 'STREET
CARMEL, IN 4.6074 CARMEL, IN 46074
..
CONFIRM TO:
AMY
--" -"CUSTOMER-P.O. SHIP VIA- F.O:B. - --- - ------ -TERMS - "-
AMY UPS -
Net 30
ITEM NO. UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT
BjM92P, EAC 288 288 0 0.700 201.60
BROWN JERSEY GL VE
Net Invoice 201.60
THANK YOU FOR YOUR. ORDER ! ! Freight 17.87
Sales Ta__ 0 .00
Invoice Total 219.47
Less Deposit 0.00
219.47
INVOICE BALANCE
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))
09/30/13 0119460-IN $219.47
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
Halsen Products
IN SUM OF $
P. O. Box 877
Belmont, MIS 38827
$219.47
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 0119460-IN I 43-560.011 $219.47 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
e
M day t er 7 013
Stte1E(Dft WMPwer
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund