27841 Blue Grass Farms of Indiana C i f C° e l CERTIFICA E
s y NO. 0 3120155 002 0 PAGE
I. PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX.EXEMPT i G
35- 60000972' i� I
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES. NP
CARMEL, INDIANA 46032 2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
I OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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N -t, u PLEASE INVOICE IN DUPLICATE
DEPARTMENT 1 ACCOUNT I PROJECT 1 PROJECT ACCOUNT I AMOUNT
PAYMENT
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 AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY.THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPRO SUFFICIENT TO PpV FOR THE ABOVE ORDER.
SHIP REPAID. �l// /LJi• >�t- 4 -Q
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE j/I °''1
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 7841 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE