225511 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 358941 Page 1 of 1
ONE CIVIC SQUARE PETTY CASH-BROOKSHIRE GOLF CO
a CARMEL, INDIANA 46032 C/O PAM LISTER CK AMOUNT: $91.82
CHECK NUMBER: 225511
CHECK DATE: 10123/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 66 . 83 FOOD & BEVERAGES
1207 4350000 24 . 99 EQUIPMENT REPAIRS & M
CLUB MANAGER RYAN SIMPSON
(317) 585-1619
INDIANAPOLIS, IN
Visit SamsClub.com
10/14/13 16:55 1277 8168 010 1758
V MEMBER 101-*******2662
THANK YOU,
KATHY VASIL
E 377608 ROMAINE I 3.90 N
E 715920 AUNT'MILLIEF 3.48 N
E 931469 HOT DOG BUNF-- 2.18 N
E 931469 HCJ DOG BUNF 2.18 N
E 931,169 HOOT DOG BUNF 2.18 N
SUBTOTAL 13.92
TOTAL 13.92
MCARD TEND 13.92
ACCOUNT # 6670
APPROVAL # 62741P
TERMINAL # MX285027
10/14/13 16:55:54
CHANGE DUE 0.00
Visit samsctub.com to see your savings
# ITEMS
TC# 7722 00228 1096 4812
IIIIIIII II IIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
PI a tell us about your shopping experience
http://www.survey.samsclub.00m
IN TURN FOR YOUR TIME YOU COULD RECEIVE
O OF FIVE$1,000 SAM'S CLUB SHOPPING CARDS
M lb e 18 or older and a legal resident of the 50 US or
to enter.No purchase necessary to enter or win.To
enter without purchase and for official rules visit:
www.entry survey.sa msclu b.corn
Sweepstakes period ends on the date shown in the
official rules.Survey must be taken within
TWO weeks of today.
a encuesta tambien se encuentra en espanol e a
pagina de Internet.
Sta nnected to Instant Savin,
Sign at Samsclub.com/ema'
10
*** MEMBER COPY ***
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4755 I::. 126"I'V ST.
CA+;MIFI.., I 033 " s�
CUSTOh1F.F: NUM?..P 40020008370
k
WT 4011 AFJta J'1`: R[PE:: 1 .30 F
70051 F B :1 IFL.I 1JRL 3.79 F "'
** j I AX (i0 fAL 5.09
2.40 1 b @ . :,,9 (1 i FAIT W1 -
CL 4011 f,IdAdFI'i' RIPE. 1 .30—F M,4
99( 3 RO1),I=F: .99 IF
1 R)41 GO EiAL 4.73
.
RSEH 5.00 �• �`� x
HACJ .27
TOTAL FIU'BEI? .IP IF[F1S SOLD = ?
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10/16/1 ? : -'? IIM 020 C11 004 ' 123
Y. OF :"C:III.R Wf'IS RSHLE:`
THAN, )T.l'lI,J Frill". SHOPPING
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Wifl y:u.r• 11:rrsh FI ::,h Ide;zl Card
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$18.65
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I Sam's I 42-390.40 I $13.92 1 hereby certify that the attached invoice(s), or
1207 I O'Malia I 42-390.40 I $4.73 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, October 21, 2013
71 q-,- �J /4 /
Director, Bro hire 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))
10/14/13 I Sam's I Food I $13.92
10/16/13 I O'Malia I Food I $4.73
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
TOR
SUPPLYC2
TractorSupply.com
18160 U.S. 31 NORTH
WESTFIEI_D, IN 46079
317-867-3505
Ticket: 277983'W~^.-•- --------..__.___—._--..—�_--
lIzrle. 10%10/13 Time: 3:20 PM
Score: 431 Register: 2
Cashier: 00235146
Customer: RUSSELL. PICKETT
Phone k: 3174201676
Company: BROOKSHIRE GOLF
Item Oty Price Amount
HSK BELT 5/8X8$IN
4461876 1 24.99 29.99 E
Subtotal 29.99
Tax 0.00
Total ~ - 24,99 --
T
Cash 90.00
Change
Cash (15.01 )
Tax Exempt Information
Name: RUSSELL PICKETT
Address: 12120 BERKSHIRE PARKWAY
CiIj''St: CARMEL, IN
Zip Code: 46032
Phone: 317-420-•1676
Tax Exempt Reason: Non--Profii/Exempt Or9
Expirattcn Date:
Tax Exempt Holder:
Under penalty of Perjury, signee declares
the ileums he/,he has purchased the
apptii_ahk_' Pruducts exempt from sales and
use tax Ira-, beers done so with the
enderstandiny ihat under state law he/she is
attesling to having a valid exemption for
ttc> purchased items. Additionally, the
ccrsterr;er at tests that all iriformat ion he/sere
has provided is accurate. Any willfully
7e representation of exemption or
customer• information is subject to penalty
under state law.
`.
This irrnsaction consists of one ar more
items exempt from siaie sales or use tax.
Before completing this transaction you
attested that the information Provided,
including name, address, and sales tax
exemption number ( if necessary), is
accurate. In addillon 1300 have declared that
rims legally have a right to purchase the
alcove items exempt from sales and use tax
for the reason indicated as defined by This
State's laws and regulations.
Go to TractorSuPPIHSurvey.com or Call
1-877-789-1443 within 7 days to
complete a survey and be entered in
a monthly drawing for a chance to
win a $25500 shopping spree.
(Awarded as Gift Cards) Ends 12/31/2013
For complete details or to Participate
without Purchase or survey, so to
T rector°SuPPly.com/customersurvey
Enter Store #: 0431
Enter Reference #: 02277483
SOLD ITEM COUNT = 1
11111�III I IIIII IIII III IIIII III MIIIIIII11
T1 LK91 KQ[iG4AM3I,1
i
Please call 877-872-7721 for Customer
Service.
Styr; up now for ads; news, and more at
3 TraciorSupply.com
Y
Customer COPY
AOL
CLUB MANAGER RYAN SIMPSON
(317) 585-1619
INDIANAPOLIS, IN
Visit SamsClub.com
10/04/13 09:14 8529 8168 010 1860
V MEMBER 101-* A-1-2662
THANK YOU,
KATHY VASIL
E 377608 ROMAINE I 3.90 N
E 680321 BROWNIE F 9.18 N
E 931462 HAM BUNS F 2.18 N
E 931462 HAM BUNS F 2.18 N
E 931462 HAM BUNS F 2.18 N
E 931469 HOT DOG BUNF 2.18 N
E 931469 HOT DOG BUNF 2.18 N
E 972893 SLICEDPROVOF 7.98 N
SUBTOTAL 31.96
TOTAL ' 31.96
MCARD TEND 31.96
ACCOUNT # 6670
APPROVAL # 95253P
TERMINAL # MX285027
10/04/13 09:15:36
CHANGE DUF
Visit samsclub.com
,--
W MALTA #206
41'55 E. 126TH ST.
CARMEL, IN 46033
(311')844-4372
4670 MM NFC OJ PULP FR NC 3.59 F
3. 13 It, @ 2. 49 /Ib
WT 4799 rOMFiTOES HYDRO 7. 79 f
CUSTOMER NUMBER 10020008370
SC 1586 MM NFC CiJ PULP FR 1 .10-F
*e*> TAX .00 DAL 10.28
Sc 4 Mg Produce Palooza 1 .56-F
* r TAX .00 DAL 8.72
CASH 20.00
CHANGE 11 .28
TOTAL NUMBER OF ITEMS SOLD = 2
10/11/13 10: 31 AM 0206 03 0030 163
YOUR CASHIER WAS MARGE
YOU SAVED
$ 22 . 66 ( 23% )
ON YOUR ORDER TODAY
*� lc� YOUR SAVINGS #**#+tkx
COUPON PLUS SAVINGS 1 .10
M-AMARKETPLACE: SAVINGS 1 .56
TOTAL. SAYINGS; (23%) S 2.66
YOUR SAVINGS +r * #**
THANK YOU FOR SHOPPING
O ' MALIA
CHECK US. OUT: Fiftp://www.omalies.com
With sour Marsh Fresh Idea Lard
You saved
$124.89 in 2012.
You have saved
5204. 19 in 2013.
Marsh Fresh IDEA Card
required for all offers.
Thank you for Shopping
Marsh!
ENTER MANNS BAKERY
5016 E 62ND ST
iNDIANAPOL15 IN
4:39F'll OC'111' 8/1.3
00-7507 002 DIANA
12456.11,
Moo @ $125
RB 24OZ M$7.50
*TTL of
CASH $20.00
c H A N GE $f2.50
THANKS FOR SHOPPING
AT ENTENNANNS BAKERY
OUTLET STORES
VOUCHER NO. WARRANT NO.
ALLOWED 20
Petty Cash
IN SUM OF $
$73.17
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 Sam's 42-390.40 $31.96 1 hereby certify that the attached invoice(s), or
1207 Entenmanns 42-390.40 $7.50 bill(s) is (are) true and correct and that the
1207 I Tractor Supply I 43-500.00 I $24.99
materials or services itemized thereon for
1207 I O'Malia I 42-390.40 I $8.72
which charge is made were ordered and
received except
Tuesday, October 15, 2013
Director, Br shire 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))
10/04/13 Sam's Food $31.96
10/08/13 Entenmanns Food $7.50
10/10/13 I Tractor Supply I Repair Parts I $24.99
10/11/13 I O'Malia I Food I $8.72
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