HomeMy WebLinkAbout103448 LEO DIERCKMAN INDIANA RETAIL TAX EXEMPT Page 1 of 1
Cityof (, IIIa]rIrr1Ie1} CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
� FEDERAL EXCISE TAX EXEMPT 103448
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AJP
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
12/11/2019 00350721 BZA Meetings in 2020
LEO DIERCKMAN Dept of Community Service
VENDOR 13316 KICKAPOO TRAIL SHIP .1.Civic Square
TO
Carmel, IN 46032-.':
CARMEL,IN 46033
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
42527
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 43-430.04
1 Each BZA Per Diem $1,000.00 $1,000.00
Sub Total $1,000.00
4.61
Send Invoice To: i.
Dept of Community Service _
1 Civic Square
Carmel,IN 46032- � .. p
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $1,000.00
SHIPPING INSTRUCTIONS *A/P 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
'SHIP PREPAID. 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 794� -45•'
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Mike Hollibaugh
TITLE Director
CONTROL NO. 103448 CLERK-TREASURER