26536 E & B PavingCity D///f Carmel
f
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
Vic; LO
THIS NUMBER MUST APPEAR ON INVOICES, AP
VOUCHER. DELIVERY MEMO. PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR
3 -Cpc..\R nS
1� o 4I Z M, d&c -. wrt kieviv,,g
N0\.9esvit1e, S'A+ 4bo o
SHIP
TO
e-?}. aC E1"C \ Any; 'i\S
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
OIJANTITV 1 UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
:I
-
Send Invoice To: • lAjzo
Yoh i- #- 09
3, (.o0a.0
200 Lo
„at---22:Eraeatistctjac
PLEASE INVOICE IN DUPLICATE
1 ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
- SHIP FEPAID, •
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 98, ACTS 1915
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 265 36
ORDERED BY
TITLE
PAYMENT
• APP VOUCHER CANNOT $E APPROVED FOR PAVMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CE fIFY THAT THERE I5 AN UNOBLIGATED BALANCE IN
THIS APPR JYIONSHFFICIENT TO PAY F THE ABOVE ORDER.
1
CLERK - TREASURER
OFFICE COPY