26535 American StructurepointeCity of'Carmmel
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 ORDLP NUMBER
LC9J2c
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
CI 1LIOI17-
A ev''CClk SNruC ✓✓cRo At
VENDOR
SHIP 1JC'7 - oe ��Cl4N QS V1 11S
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
DUANTITY (UNIT OF MEASURE
DESCRIPTION
Send Invoice To: 1
AsR -4 9
�ov`�ra 4
UNIT PRICE
EXTENSION
PLEASE INVOICE IN DUPLICATE
2 2 (04 (0 ° °
2_OO Gov
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE OPUER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
TITLE
26 CLERK- TREASURER
DOCUMENT CONTROL NO. OFFICE COPY
AMOUNT
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO-
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED,
• I HEREBY CEJiTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APRRY1f[ DTI• - DEFICIENT TO AY FOR THE ABOVE ORDER.