26182 Institute for Publie Safety C Q¢.� ��y� INDIANA RETAIL TAX EXEMPT PAGE
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LL t o i arm e J CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
y psi w FEDERAL EXCISE TAX EXEMPT 26192
35- 60000972
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
5@912012 i
Institute for Public Safety Porsannol, Inc. Cannel Police Department
VENDOR SHIP 3 Civic Square
251 East Ohio Street, Suite 1000 TO Carmel, IN 48032
Indianapolis, IN 48204 (317) 5712559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
Account 43-407.03
1 Each fit for duty psychological $750.00 $750.00
Sub Total: $750.00
Account 43.419.99.
2 Each psychological evaluations ��I Al $380.00 $720.00
4 0 W Triy Sub Total: $720.00
Psych for Seth Goldstein Juan N a V
Send Invoice Q: Jr� f
t ra 1 Jl f� �j j
Carmel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 48032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT 1 PROJECT PROJECT ACCOUNT 1 AMOUNT
,Carmel Police Dept. 'v7 PAYMENT $1,470.00
AIP 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 APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY \t I i
PURCHASE ORDER NUMBER MUST APPEAR ON ALL L lo
Of POIIco
SHIPPING LABELS. A 1 Ch
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE IT.
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
26182 CLERK- TREASURER
DOCUMENT CONTROL NO. OFFICE COPY