32358 National Business InstituteCity of 4 Carmel
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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
3a35g
THIS NUMBER MUST APPEAR ON INVOICES, AP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
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VENDOR - O , IOX so Lo
E L Claire) tol 5L/70
SHIP
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE I
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
IReiSt-ration -Dr Jon OberlanJar
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PLEASE INVOICE IN DUPLICATE
35q, 00
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT.
AMOUNT .
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/ I O O
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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.
DOCUMENT CONTROL NO. 323 58
I
PAYMENT Z.5 q ea
• 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 THE . :: ED BALANCE IN
PROPRIATI•: e. IENT TO PAY FOR T ABOVE 0
ORDERED BY
CLERK - TREASURER
OFFICE COPY