102126 ALAN POTASNIK o INDIANA RETAIL TAX EXEMPT Page 1 of 1
Cit ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102126
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
11/19/2018 357681
ALAN POTASNIK Dept of Community Service
VENDOR 12482 CHARING CROSS SHIP 1 Civic Square
TO Carmel, IN 46032-
CARMEL, IN 46033-
PURCHASE ID 7 BLANKET CONTRACT 1 PAYMENT TERMS FREIGHT
31173
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 43-430.04
1 Each Plan Commission and Board of Zoning Appeals Per Diems $2,700.00 $2,700.00
Sub Total $2,700.00
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Send Invoice To: t£
Dept of Community Service
V
1 Civic Square `''' ,_
Carmel, IN 46032- a w '
PLEASE INVOICE IN DUPLICATE
I- DEPARTMENT 1— ACCOUNT F---------1,R,--5:ECT PROJECT ACCOUNT AMOUNT
PAYMENT $2,700.00
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 0.D SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL /�7�
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ( „-'e \h
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Mike Hollibaugh
TITLE Director ��
CONTROL NO. 102126 CLERK-TREASURER