PublixP Yu •
X i�urrcan� 5��1�PS
!' snores ' 1, . aa.05a5.a -5• say_ 3� a
9(15(1 Biscayne Blvd
Miam; Shores, FL 33138
Store Manager: Zo Perr•y �
PBX SWEET COLESLAW! 4075
PBX
SWEET CUEESLAW
PBX SWEET COLESLAW
4.33 F
4.33
PBX HOMESTVLE POTO
F
4.33 F
PBX HOMESIVLE POTD
PBX HOMESM
5.15 F
5.15
-E PDTD
F
Order Total
5.15 F
Sales Tax
28.44
Grand Total
0,00
(,redit
Change Payment
28.44
Mode:
28.44
AMfIl /NT
0.00
PRESTO!
Request NUL Authur'i2ed
AcAcct ct # # XXX.XXXXXXXXX9
Reason:EFT Oecli 828
ne Reas
Trace #: 145589
Reference #:0669056884
09/26
145589101/
10:25: l:T
CREDIT CARD
PURCHASE
CARD #;
Trace #:145589
Chip Card:
XXXXXXXXXXXX982e,
Chlp Card AID:
Arc:
VISA CREDIT
A0000000031010
TC;
INVOICE;
0046
1070030IC8758511
Approval Code.
Entry Method:
145589
Mode:
00
Chin Verified
SALE
AMfIl /NT
DECLINED
BY ISSUER $28.44
P U b i'lo x
Miami Shores
905(1 Biscayne Blv,l
Miami Shores, Ft_ 3:113if�Q���
51:aie Manager: Zo Peri
305- 751 -4075
PBX SWEET COLESLAW 4.33 F
PBX SWEET COLESLAW 4.33 L
PBX SWEET COLLSLAW 4.,13 F
PBX SWEET COLESLAW 4.33 F
PBX SWEET C01_ESLAW 4.;i3 F
PAM SPRAY 2.95 F
ONIONS SWEET
0.86 lb N 1.291 lb 1.11 F
You Saved 0,25
PBLX BROWN SGR 1.09 h
PBLX BR(INN SGR 1,09 F
OF Total
27,89
Sale; 'fax
O.pU —
Grand Total
'77 89
Credit Payment
27.89
Change
0.00
4Y inks _SuomrarY
Sf7(Iclal Price. ,ivjfjUs 0,25
# Your Saving;; at Publix #
# 0.25 #
PRESTO!
Trace #: 120)08
Reference #: 0670u25708
Acct #: XXXXXXXXXXXX9828
Purchase VISA
Amount: $27,89
Auth #: 067851
o912712017 �09:40:20
120108
CREDIT CARD
PURCHASE
CARD #:
Trace #:12olo8
XXXXXXXX.X.XXX9828
Inch Y•0(ri7T
R,u rri CcLne- S"pf)l;e S
ISo• a5.ogas. aS •Sa5_sa -310
I
i
MIAMI SHORES VILLAGE
VISA CARD PAYMENT VOUCHER
1. Attach original credit card receipt.
2. Submit one form per credit card receipt.
3. Submit to Finance Department within 5 business days of receipt.
Date of purchase: 12-1 ))e
L
Cardholder Name ' > Vj j f
Name of Vendor: �U l 1 X
Description of Purchase / Notes:
tl\ I
�) W
Ids, ""
Amount of purchase: S • O
Budget Code: /,5-U d 5 _ 05Q tr. "25 . j.) S _ 5D -3/O
Y
These purchases were actually incurred as necessary business expenses and are true and
correct as to every material matter.
Submitted By:
Approved:
2- do
Card Holder /Designee Signature
N1 Gr cR_.
De artment Head Sian re
Payment Authorization:
Finance Director Signature
Distribution: Department HeadS /Designee
q -� t -I-)
Date
Date
Date
Updated: 06/19/2017
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PubIlex
Miami Shores 1
S050 Biscayne Blvd n1��
Miami Shores, F, - 33138
Store Manager: 7 Lo Per `
305 - 751 -4075 /1 ^'
G2 FRUI PUNCH{ HIV\
6 4 ^ FOR 10.00 v� 30.00 ' F
You Saved 11.34
G /ADE ASPASP LEMN DE
7 '1 2 FOR 10.00
You Saved 35•GC T F
G2 GRAPE 13.23
5 # 2 FOR 10,00 25.00 T F
You Saved 9.45
G2 ORANGE
3 M 2 FOR 70.00 15. DG T F
You Saved 5.67
G2 LEMON LIME 8Pi(
4 # YOU 2SFOR 10.00 20.00 T F
G /ADE FRST 8PK 7.56
1 2 FOR 10.00
You Saved 5.00 T F
HAWAIIAN PUNCH 1.89
FANTA ORANGE 5 55 16.65 T F
FANTA ORANGE 5.49 T F
FANTA ORANGE 5.49 T F
Promotion 5.49 T F
vendor Coupon -5.49 T F
TAX EXEMPT # -1.00 F
Order Total
Grand Total
156.63
Credit Payment
156.63
Change
156.53
0.00
TAX FGRGIVEN
11.04
Sa s ,&- �T2Lr.
vendor Coupon
Special Price .Savings
%00
54.63
* * # * * * * * * * * * * + * **fi + *� *..
trUrr; cane SuppIIeS.