26493 PKS Construction City I' INDIANA RETAIL TAX EXEMPT PAGE
of l CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT Q
35- 60000972 nq S t'A h/ 1. Q -J..
5 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A
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?-5 c
IC Can huc J /1U /U 1 Oc j
VENDOR `t Q So U -14 I �-e? '4- J LL It SHIP
,G,�09 ,per, T� 1407/ q TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
3QJ /90-67)11 371a 3, ,S9e
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Send Invoice To: a U
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C d (0 y6c3Z
PLEASE INVOICE IN DUPLICATE
Lc Z909
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
120 S j d PAYMENT
AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
i VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CEFFIFY THAT THERE I5 AN UNOBLIGATED BALANCE IN
THIS APPR ON'SUFFICIENT TO ABOVE ORDER.
SHIP REPAID.
y C.O:Q. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. b
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1995 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
t' CLERK- TREASURER
DOCUM CONTROL NO. 2 6 4 9 3 OFFICE COPY