31918 C H A ConsultingCif of Calomel
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
31g15
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
12/11 /I4
VENDOR
OH
Union Sta -ii on
300 Sot-et In Meridian Sire et
nd'cviolls, IN
4-(D 22 S
SHIP
TO
E 9 rmas
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
Enytneeen r�
LPA COnS Itcini Contract
State De s # 133311'' 5
131' - -5 S1rcet PcLrk -
keys -rone to Gray Road
COnstrL.4 C4, on InSpe C+�o•'1
PLEASE INVOICE IN DUPLICATE
�.o be Kelmburscd 6"/
State
NTE:
3169,0i-to -
$ 5X32.0
5.,2ss.1y
a b23.00
,4g0.N3
A 1.4 . �1 �
V S(,,3ocr-
goo- y4to2s1.-
o3- yyunoo
II-43Ho100
211 -y35Oc6OO
2 I I-R4-1350(100
2200 - 4350900
DEPARTMENT
ACCOUNT '
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.0.0. 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. 31918
t
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
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 APPROPRI J�ONN �SUF'F�hC IIEENNNTT TT�O PAY,FOR THE ABOVE ORDER.
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