31785 Midwest ConstructorsCi
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
x/7/5
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
VENDOR it f /I 10)511v (jor
2'/ I B ,41+ (?oAJ , 54,; a t D
II,,l;r T4/ U627 S
SHIP
TO
( ft �/ �/
>U W ��1 /t >l. 2"lijP 220
7 i-M e l J T 4/ 14032
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To (1?(
i
VDT k
(4) mP , 0Y2
PLEASE INVOICE IN DUPLICATE
12o3, g oo0
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
946 D'1 -)
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
• A/P 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 ABO 0 D R.
}
p CLERK - TREASURER
I DOCUMENT CONTROL NO. 31785 5 A.P.V. COPY - SIGN AND RETURN TO CLERK'S OFFICE