27357 Mid State Truck C1111 1111 i ty INDIANA RETAIL TAX EXEMPT PAGE
f Carmel O/ sane l CERTIFICATE NO. O. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 2
35- 60000972 of 3
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, ;VP
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
`.'1"ljd ST, TR J fl y "r _1 N
VENDOR I l7 U 11 G L !D O SHIP
TO
r_54't 1/6 03(
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
955 8 6 culil v.- yT
JNacJ6, c 00
i J S7j
L 6-47-y. 74 �.�2:,. II yoo
er OF Al As? 'it,
4 1 V
i
a 3 1111111/4.‘
lie ..1
o ti
Send Invoice To
T. �M, �lfrlf%lf J
6,,, a. ,S
PLEASE INVOICE IN DUPLICATE i 15 7 ,7J-
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT
Z D_i (i 35- PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER 15 MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE P OPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY T/ AT THERE ISANUNOBLIGATED BALANCE IN
THIS APPROPRIA e EICIENT TO PAY FOR TH ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. e
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE N
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. I
2 7 3 5 7 CLERK- TREASURER
DOCUMENT CONTROL NO. OFFICE COPY