20711 Republic Services /r�1 ®I{° ar ei INDIANA RETAIL TAX EXEMPT 15500 PAGE
C 1 ,1Lr CERTIFICATE TAI TAX 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 11
3 5-60000972
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ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES. Al
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SUP:
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
JRCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
2-3 (bola Pp
VENDOR SHIP 7c i COL/ r p
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ONRRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION I UNIT PRICE EXTENSION
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Send Invoice To
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PLEASE INVOICE IN DUPLICATE i„ g j
DEPARTMENT ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
7 i'E35R'l o I PAYMENT
AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER $WORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBUGATED BALANCE IN
SHIP REPAID. THIS APPROPP,IATION 'SUFFICIENTTOPAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY f i�
PURCHASE ORDER NUMBER MUST APPEAR ON ALL I 1 it
SHIPPING LABELS t 1
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945 TITLE �j•j4,
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
:j l 11 CLERK TREASURER
DOCUMENT CONTROL NO. OFFICE COPY