226033 11/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366015 Page 1 of 1
ONE CIVIC SQUARE WEX BANK
CHECK AMOUNT: $261.85
CARMEL, INDIANA 46032 PO BOX 6293
CAROL STREAM IL 60197-6293 CHECK NUMBER: 226033
CHECK DATE: 11/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4231400 34670932 261 . 85 0490-00-138002-1
I nvoi ce Statement
INVOICE NUMBER: 34670932
190 ACCOUNT NAME: City of Carmel Admin.
PAGE 1 OF 1
ACCOUNT NUMBER CREDIT LIMIT DAYS THIS PERIOD BILL CLOSING DATE PAYMENT DUE DATE AMOUNT DUE
0496-00-138002-1 1 550.00 31 0 CT-31-2013 NOV-26-2013 1 261.85
DATE ACTIVITY DESCRIPTION CHARGES/DEBITS PAYMENTS/CREDITS
OCT-18-2013 PAYMENT-THANK YOU 226.63
OCT-31-2013 FUEL PURCHASES 261.85
REMINDER
REMINDER PLEASE BE SURE TO INCLUDE REMITTANCE STUB
WITH PAYMENT. MAIL TO THE ADDRESS SHOWN IN THE
RIGHT PORTION OF THE REMITTANCE STUB.
NOV. 2013
By
PURCHASES RETURNSAND PAYMENTS MADE JUST PRIOR TO BILLING DATE MAY NOT APPEAR UNTIL THE NEXT INVOICEISTATEMENT.
PREVIOUS BALANCE PAYMENTS (+)PURCHASES (+)DEBITS I OCREDITS (+)LATE FE (=)NEW BALANCE
226.63 226.63 261.85 0.00 0.00 0.00 261.85
CALL CUSTOMER SERVICE TO PAY BY PHONE
FEDERAL TAX ID: 841425616 The Late Fee is determined by Which is an EFFECTIVE ANNUAL To the balance subject to late
applying a monthly rate of RATE of fee for this period which is
2.249 % 26.99 % 0.00
SEE REVERSE SIDE FOR IMPORTANT INFORMATION AND TERMS.
---------TO ENSURE PROPER OREDI T-TEAR AT PERFORATION AND I- -QQE_e_Q -_QM_PORTI QN WITH YWR PAYMENT.
ACCOUNT NAME City of Carmel Admin
ACCOUNT NUMBER 0496-00-138002-1 Circle K Fleet
INVOICE NUMBER 34670932
BILL CLOSING DATE OCT-31-2013 FAX CHANGE OF ADDRESS REQUEST TO 1-800-395-0809.
Make check payable to:WEX BANK.
AMOUNT DUE 261.85 l Use enclosed envelope or send to:
AMOUNT ENCLOSED
PAYMENT DUE DATE NOV-26.2013
PAYMENTS RECEIVED AFTER THIS DATE SUBJECT TO LATE FEES A
Itllttlltttntllltlt�ltnitllttttltlltlttnlltltttll
WEXBANK
P.O. BOX 6293
CAROL STREAM IL 60197-6293
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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
PO OX
Date Due
'rn, 1L 60197 632113
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10731113 34670932 Gasoline - Admin Dept $261.85
$261.85
Total
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 NP./12/13 WARRANT NO.
WEX BANK (Circle K Fleet) ALLOWED 20
PO Box 6293 IN SUM OF $
�arnl��tr�afla, 1i 6019:7-6293
$261.85
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
314 $261.85 received except
20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund