20013 Sensory TechnologyCl 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
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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
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t°2-167
PA
VENDOR
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6 S fp0/4_1C Cyct.i
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SHIP
TO
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CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
PA
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
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PLEASE INVOICE IN DUPLICATE
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DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
/,267
y350000
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.
21013
DOCUMENT CONTROL NO.
ORDERED BY
PAYMENT
• NP 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
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
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TITLE 601 15-up Lri v='/ wrnz 7
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CLERK - TREASURER
OFFICE COPY