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o INDIANA RETAIL TAX EXEMPT Page 1 of 1
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City of Carme CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101149
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/14/2017 372138
TERESA&JEFF EVANS Dept of Community Service
VENDOR 125 YORK DRIVE SHIP 1 Civic Square
TO Carmel IN 46032-
CARMEL, IN 46032-
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PURCHASE ID BLANKET CONTRACT PAYMENT TERMS k FREIGHT
21829
QUANTITY UNIT OF MEASURE
DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund 101 General Fund
Account .43-590.29
1 Each Facade Grant j $2,325.00 $2,325.00
Sub Total $2,325.00
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Send Invoice To:
Dept of CommunityService a l
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
PAYMENT $2,325.00
SHIPPING INSTRUCTIONS *AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
*SHIP PREPAID. PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL / �,
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 '-' •"[=
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY �
Mike Hollibaugh \l
TITLE Director \' ?
CONTROL NO. 101149 CLERK TREASURER ,\ _ ,,:-3._4,
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