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INDIANA RETAIL TAX EXEMPT 155 00 PAGE
"�/JnL IJLr 11�/ CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 3�J )?).51?
• 35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP
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 ,
I2W 3 I
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VENDOR SHIP
TO ar,m_. C,- i c St, -
CaV C-A , =C-rl 2h 23Z
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT -
QUANTITY UNIT OF MEASURE DESCRIPTION • UNIT PRICE EXTENSION
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%H°. .,,,. 44...i...wev/ , a
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Send Invoice To: O� C .„ ��
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1Z.2\ ° 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 CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• SHIP REPAID.
• C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY • 34ja L J 1_ ,(L �� 'lJ-NV�-+t�',
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL /�Mf
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE '
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
31656 CLERK-TREASURER
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