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4 INDIANA RETAIL TAX of C arme l CERTIFICATE NO. 031201 5 02 0 PAGE
s; y .u. PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT g CO %o s
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
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
L N wv o r canne
I
1I Vr SH IP CiI y o l/�yrrc -1
VENDOR 1 TO O Ae C WI JI 1A(,{ (C�.-
Carmel T of 1 1(o5z
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY 1 UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
V
1 Coll 19 Class 7Za,, D HDTV 4 91! q9
0
7 -Taw
j
l ial p i, ii 0.:
mo a
Send Invoice To: r
bet*. ►Z03 1/ 7100)
OcC 0y&LSOO
TOTAL—
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER 15 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
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID. /�/7 MLA--
C.O.D. SHIPMENTS CANNOT BE ACCEPTED
ORDERED BY NN KX� 1 i w. i� ---!!1 y /9/ L
PURCHASE ORDER NUMBER MUST APPEAR ON ALL //�1 C (�a� i %I�� Y Fµ"' �r f �/V/
SHIPPING LABELS. .A N J,dl
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE ,rJ
AND ACTS AMENDATCRY THEREOF AND SUPPLEMENT THERETO.
2 6 4 5 C TREASURER
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