26467 Van Ausdall & FarrarCi
of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
THIS NUMBER MUST APPEAR ON INVOICES, HP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
S -a3 - 1)-
X-
� I /(i /% r
VENDOR
140 411SJLtta /22 /MY
643.0 5RET '75wc 5{-r.,u •
72)01, Ire) riroL.c .
ij &zoo 01151
SHIP
TO
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S�r�rr��
64FiCI✓!e:.,.
CA,e,rltiC. ✓ 14, a3
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
X-
� I /(i /% r
QUANTITY
UNIT OF MEASURE V DESCRIPTION
UNIT PRICE EXTENSION
1Lt1,41 1-5a, SS 3-0 G'imul r--
111:S/2134 / II 7j-I rh c'' 3fr7
Fsec Syr
c6J T
..2-51/6 ni 45, ,da•ih)
%, 7, A 1 .,6'75/.6")
1024,0.
-703 t41'
Send Invoice To:
4I ;4 n) 5 ,4
C/0 CM( OP Cy�L-
�jJ #'"j7Ln �•' !� C ani,rut n /fl/
Y" ✓I C.Ps.a
onQIL'Ic_
«5 n60-
PLEASE INVOICE IN
DUPLICATE
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.0 U. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON AI.L
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
TITLE
PAYMENT
• HP VOUCHER CANNOT BE APP RCVS) FOR PAYMENT UNLESS THE P0.
NUMBER 15 MADE A PART OF TTHE VOUCHER AND EVERY INVOICE AND
VOCHET -1AS THE PROPER $WORN AFFIDAVIT ATTACHED,
I HEREB C'RTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS A R PRIATION SUFFICIENT TO AY FOR THE AUOVE ORDER ...-
26467 CLERK - TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY - SIGN AND RETURN TO CLERK'S OFFICE