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INDIANA RETAIL TAX EXEMPT PAGE
of CERTIFICATE N0. O. 003120155 155 00 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972 02! 020 Q
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES. A/P
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
SHIP /0
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VENDOR ✓27 6 /igen c (P£ i/Ylc TO
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CONFIRMATION BLANKET _CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: to il J� j
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vb° PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
/a0 4"5sVV Z 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 THATTTHERE ISANUNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION EI ENS-TO PAY FOR THEVOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. I
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. 1
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
ANDACTSAMENDATORYTHEREOFANDSUPPLEMENTTHERETO.
2 0 7 0 8 CLERK- TREASURER
DOCUMENT CONTROL NO. OFFICE COPY