225197 10/15/2013 CITY OF CARMEL, INDIANA VENDOR: 359294 Page 1 of 1
ONE CIVIC SQUARE MID AMERICA BEVERAGE INC
CARMEL, INDIANA 46032 PO Box 2856
CHECK AMOUNT: $342.45
KOKOMO IN 46904-2856
CHECK NUMBER: 225197
CHECK DATE: 1011512013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 342 . 45 FOOD & BEVERAGES
MI ERICA INVOICE
B IMCE • CITY OF, CARMEL,. , . , . . ,
dba BROOKSHIRE GOLF CLUB
INC. 12120 BROOKSH`IRE PARKWAY
2755 Commerce Dr. CARMEL IN 46032
P.O. Box 2856
rt`r` Kokomo, IN 46904-2856 RR2903542 EXP. 07/1 /1
765-459-3117
800-382-0675
Fax: 765-457-7967
BEER W3409212
INVOICE DATE INVOICE NUMBER SALESMAN NUMBER CUSTOMER NUMBER ROUTE
10/17/13 539593 Dustin Smith t 13 800 13
CODE.
QUANTITY
BASE Sepember 30, 2013
PROMO #0913
Wine: W342887
Pump $52/$47 Refundable
109 4 Budweiser 24 Lse Can 18.60 74.40
209 E3 Bud Lt 24 Lse Can 18.60 148.BO
909 .1 Minh Ultra 24 Lse Can 19.30 19.30
1537 3 Stella 2/10 Pack 14.9 oz 24.E30 74.40
7025 1 Goose 312 2/12 Can %g,'.- 25. 55 25.55
} Y6...:.
Cases 17
• • • • TOTAL SALE
342.45
10303 EMPTY AB 1/6 30.00 T
10304 EMPTY AB 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
342.45
`P7 ® CREDITS
/9❑ Cash ❑ EFT ❑ Escrow ® Check Number Z
I �
Driver �
er _ � Received By
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid America Beverage Inc.
IN SUM OF $
P.O. Box 2856
Kokomo, IN 46904-2856
$342.45
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#ITITLE AMOUNT Board Members
1207 I 539593 I 42-390.40 I $342.45 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, October 17, 2013
Director, Broo �e Golf 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))
10/17/13 I 539593 ! Beer I $342.45
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