31904 Central Indiana MitigationCi of Carniel
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
31gi01-
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
-10 I Ct I II-1
VENDOR
Cer, hen 1 Indiar+4 MIti9a.-1ion
Provlde• -r, LLC
2-1 s Batty Street tr sLt te4YS10
Sae, F- nano s cp , CM 841 1 1
SHIP
TO
Dept. oFir Ern..- ,eenrr
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
Cn5 1/ -+
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
etc
t -Ac.,n S+v -cct• Reco-u14Ctia\
we-t and s ri1l+i3 co- on
p 1.Cr.a.0 AgTeerrent
PLEASE INVOICE IN DUPLICATE
A g eerne"t 51c3ned:
1o/1 (II
NTE : S35,200
2 00 c Body
00
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• COD. 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. 31904
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
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 APPROPR1I B - IENT TO PAY FOR JFIE ABOVE ORDER.