26173 Public Safety Medical Services C 0 INDIANA RETAIL TAX EXEMPT PAGE
i 1 y C arme l CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26173
e
35.60000972
ONE CIVIC SQUARE .I THIS NUMBER MUST APPEAR ON INVOICES, A!P
CARMEL, INDIANA 46032 -2584 .J 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
512212012
Public Safety Medical Services Cannel Police Department
VENDOR SHIP 3 Civic Square
324 E. New York Strreet, Suite 300 TO Carmel, IN 48032
Indianapolis, IN 46204 (317) 5712559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
Account 43- 407.01
1 Each psych physical for applicant $675.19 $675.19
Sub Total: $875.19
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tT
Gabrielle Padill o ej
Send Invoice io:
JO
Cannel Police Department
Attn: Teresa Anderson
3 Civic Square
Cannel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
Cannel Police Dept. PAYMENT $675.19
A/P 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 HERRH THERE IA TED AA
THIS APPROPRI EBY CE TIFY T UFFI ISAN TOP UNOBL FOR G THE ABOVE BL ORD IN ER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. Chief of Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
I,
CLERK TREASURER I
DOCUMENT CONTROL NO. 26173 OFFICE COPY