31838 AMERICAN STRUCTUREPOINT•
armel
ONE CIVIC SQUARE
CARIVIEL, 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
3tea 3%
THIS NUMBER MUST APPEAR ON INVOICES, NP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
; DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
sit IILI
VENDOR
Amer■ C 0.r- S-MuG;u reV")()''�
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It ,dlclr-iGPO1a s, IN 4 (025(0- 79G-1-
SHIP
TO
DePi-. E
CONFIRMATION
BLANKET
CONTRACT
- PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
Send Invoice To:
UNIT PRICE
EXTENSION
ASA # F
Coe.- a c +; Dq.!-C 3/20/13
?roject (4 -O(o
M
12,e- c dn s -h-• La cti o r%
PLEASE INVOICE IN DUPLICATE
NiE 13 3 GI ,3oD
* 6 1 , 2 , 0 0 — '2o2 - 440560
-*102 , 0o0 -- 202- LKO
AI, 0` 6,. SO : - 2 0 2 - 5,w
DEPARTMENT
ACCOUNT,
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS •
..• SHIP REPAID. •
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. "• 'L, - t
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 31838
ORDERE
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 HERFRY CFRTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION Sl, „ . T.T,Q.BAY.F E ABOVE ORDER.
TITLE
CLERK - TREASURER
OFFICE COPY