226837 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 365556 Page 1 of 1
ONE CIVIC SQUARE TIMOTHY VANDERGRIFF CHECK AMOUNT: $79.97
CARMEL, INDIANA 46032 963 E 300 S
TIPTON IN 46072 CHECK NUMBER: 226837
CHECK DATE: 12/3/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 79 . 97 OTHER EXPENSES
Kokomo ..
Kokomo, IN 46901 .
(765) 854-0420
11-23-13 2:31P 0690/0011/5252/9 2492XXX
ID# 999-8876-8685-6897-9309--8847-4790
YM DENIM 083624854952 * 29.99 T1
ItemPrice 48.00 YouSave 18.01
LEE PREM SELECT 690742501639 29.99 Ti
ItemPrice 48.00 YouSave 18.01
MENS LEVI JEANS 052177360128 39.99 Ti
ItemPrice 58.00 YouSave 18.01
SUBTOTAL 99.97
r, TRANSACTION DISCOUNT 20% ,. 20.00-
T1= 79.97 @ 7.0% TAX 5.60
TOTAL . $85,57
a,.,... XXXXXXXI". '85.57
APPROVED 000001
ilk TOTAL SAVED; $74,03
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WE DO PRICE ADJUSTMENTS!
If something you purchasedgoes on sale,'
bring it back with the receipt within 14 days
and we'll give it to you for the sale price.
HASSLE-FREE RETURNS
RETURN ANY ITEM,ANYTIME, FOR ANY REASON.
DO YOU HAVE YOUR RECEIPT?'
You'll get a full refund or even exchange.
If you have a gift receipt,you'll get an
even exchange or a Merchandise Credit.
NO RECEIPT?NO PROBLEM! ,
If you paid with a Kohl's Charge or any other major
credit card,we can look up your purchase and give
VOUCHER # 133481 WARRANT # ALLOWED
TVANDERGRIFF IN SUM OF $
TIM VANDERGRIFF
3450 W 131 ST ST
CARMEL, IN 46074
i
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
Ol 1rz;2LY^-O 3
4790-G $79.97
I
I
4
Voucher Total $79.97
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
TVANDERGRIFF
TIM VANDERGRIFF Purchase Order No.
3450 W 131 ST ST Terms
CARMEL, IN 46074 Due Date 11/26/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/26/201, 4790 $79.97
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
Date Officer