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ONE CIVIC SQUARE
• CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
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THIS NUMBER MUST APPEAR ON INVOICES, NP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
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VENDOR yoa5 S+ree+
Pl;ilacl- elph'icc., PA Igl01-1-3Q j
SHIP
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
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PLEASE INVOICE IN DUPLICATE
1,18"9.30
DEPARTMENT
- -ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
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4135 -7Q0L/
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SHIPPING INSTRUCTIONS •
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �\
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 I �� • r I U' \/
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE ✓� n
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
▪ HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
DOCUMENT CONTROL NO. 32360
CLERK - TREASURER
OFFICE COPY