101999 HENDERSON IMPORTS LTD CII .
INDIANA RETAIL TAX EXEMPT Page 1 of 1
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CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
JL FEDERAL EXCISE TAX EXEMPT 101999
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL,INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
10/11/2018 365866 Belt
HENDERSON IMPORTS, LTD Fire Department
VENDOR 2584 GARFIELD ROAD NORTH,STE.43 SHIP 2 Civic Square
TO Carmel, IN 46032-
TRAVERSE CITY, MI 49686-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
30039
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-560.01
1 Each GMPB44 44 Plain Hide Kilt Belt 2 1/4'Wide with Shipping $43.55 $43.55
Sub Total $43.55
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Send Invoice To: ...., q _ k,
Fire Department �'�� `n', 7 ``
2 Civic Square /F,
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT 6 ACCOUNT I PROJECT I PROJECT ACCOUNT D AMOUNT
PAYMENT $43.55
SHIPPING INSTRUCTIONS *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
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
*PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELti W„.
*THIS ORDER ISSUED 114 COMPLIANCE WITH CHAPTER 99,ACTS 1945
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AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY t \-V
Denise Snyder
TITLE Budget&Accreditation Manager Q�\
CONTROL NO. 101999 CLERK-TREASURER \
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