32375 Church Church Hittle AntrimCity f Carmel
lepor -4 v-m-f of I-Q LJ
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
333-75
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
(Aur (Ili Ghxxc,1 Mfit 4Anirin�
VENDOR
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
✓i cps re/clued
�- di y 0-1: ea(Yvti/ e 44) )
a1+a.c d
090 /1-/ EfC06/6(anCe
PLEASE INVOICE IN DUPLICATE
DEPARTMENT
, ACCOUNT
PROJECT
PROJECT ACCOUNT
1,11W (r4314-ce0000
i..5
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. 32375
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
AMOUNT
PAYMENT 000, Ov
• 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
THI .A ' • SUFFICIENT TO PAY FOR THE ABOVE ORDER.