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5 INDIANA RETAIL TAX EXEMPT
C if o'. f a rm e 11 CERTIFICATE NO. 003120155 002 0
�1.��a PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT c
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35- 60000972 1 J
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AN
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
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
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QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: r O L C-
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c: ,173 G31 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFYTHATTHEREISANUNOBLIGATEDBALANCEIN .p•
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID. y .y
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. �0, ••"/"-i< �.L_L
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY w I
1 SHIPPING LABELS. r f
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 2784 O A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE