209273 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 00350617 Page 1 of 1
it ONE CIVIC SQUARE NATIONAL BUSINESS INSTITUTE
CARMEL, INDIANA 46032 PO BOX 3067 CHECK AMOUNT: $339.00
off EAU CLAIRE WI 54702 CHECK NUMBER: 209273
CHECK DATE: 5/22/2012
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1180 4357004 339.00 EXTERNAL INSTRUCT FEE
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Re gistration Form iPl?as2 photocopy .his fern, hx n�:dtip!e rxaisoanrs.) P.O. Box 3067 FAX: 715- 835 -1405
Name Ashley M. Ulbricht Title Assistant City Attorney Eau Claire, Wl 54702 ONLINE:www.nbi- sems.com
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INDIANA RETAIL TAX EXEMPT PAGE
Cl of Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 1 1
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ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
PAYMENT .d
A/P NU VOUCHER CANNOT BE APPROVED FOR PA U THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. rl f
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. Y
CLERK TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY SIGN AND RETURN TO CLERK OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
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ON OU NT OF APP dP RIATION FOR
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PO# or INVOICE NO. ACCT #!TITLE AMOUNT
s`rr' I hereby certify that the attached invoice(s), or
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bill(s) is (are) true and correct and that the
53 materials or services itemized thereon for
which charge is made were ordered and
received
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