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( CERTIFICATE
EXC SE TAX EXEMPTO PURCHA1S0E ORDE5R0N UMBER
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
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 372139
TAWNI GRAY Dept of Community Service
VENDOR 815 COLLEGE:WAY SHIP 1 CivicjSquare
TO Carmel, IN 46032
CARMEL,IN 46032-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
21830
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 43-590.29
1 Each Facade Grant $1,200.00 : $1$1,,200200..00
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Send Invoice To:
Dept of Community Seryice j
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT A PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $1,200.00
SHIPPING INSTRUCTIONS 'A/P 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 19
45
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AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY / \J
Mike Hollibaugh V�
TITLE Director ,x)
CONTROL NO. O1 50 CLERK-TREASURER
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