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of Carmel
ONE CIVIC SQUARE
CARMEL,. INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
c,5-502 I
THIS NUMBER MUST APPEAR ON INVOICES, A!P
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR
SHIP
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY 1 UNIT OF MEASURE
Send Invoice To:
DESCRIPTION
UNIT PRICE
EXTENSION
#1640W-7) CvloCPx.6e ..f
PLEASE INVOICE IN DUPLICATE
,da
DEPARTMENT
1
acv /l t n'vA"
ACCOUNT
PROJECT
PROJECT ACCOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL.
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
25321
DOCUMENT CONTROL NO.
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
• 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 AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THISAERRORRIAT,IONSUFFICIENT"TO PAY PORTHE ABOVE ORDER.
AMOUNT