32355 4ImprintCi
kof 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
3a 355
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
q)3)2o11-I
.
VENDOR
1-/ Hphn+
�Q! eom,me(e -e,9,
P.O. (Sox 3,90
i<D3h , W 15 Al q o
• SHIP
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY I UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
--1)(on0ahonaA cm -hnals per tip
Send Invoice To:
hOU IGS C• Ha (Leg
e- A Est
eI ±‘ o-F 661rnd'
Orna C,VIL Sgot(e
Cc,(,ite.), IN L11o03a
PLEASE INVOICE IN DUPLICATE
/y/,5 6I
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Lai - if
/135-5/ 00 ]
YOnao-h o✓ ec, (ICI
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.
ORDERED BY
TITLE
PAYMENT
44/ip5. o r
• 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
TH19-APPROQDIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
CLERK - TREASURER
DOCUMENT CONTROL NO. 32355 A.P.V. COPY - SIGN AND RETURN TO CLERK'S OFFICE