102168 PLUM CREEK GOLF CLUB City Carmel INDIANA RETAIL TAX EXEMPT Page 1 of 1
®f CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102168
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
11/29/2018 358203
PLUM CREEK GOLF CLUB Dept of Community Service
VENDOR 12401 LYNNWOOD BLVD SHIP 1 Civic Square
TO Carmel, IN 46032-
CARMEL, IN 46033-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
31387
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 43-590.29
1 Each Façade Grant $5,000.00 $5,000.00
Sub Total $5,000.00 '
Send Invoice To: 4.
Dept of Community Service /
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT V PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $5,000.00
SHIPPING INSTRUCTIONS '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
'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 LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 1
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Mike Hollibaugh
TITLE Director ,.
CONTROL NO. 102168 CLERK-TREASURER C•