26534 Crossroad EngineersCi
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, AiP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR vcX,sv oad a 71 As_s V$
SHIP •
TO � _ e.f SI 1
CCNRRMAT@N
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY I UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
ASPic
PLEASE INVOICE IN DUPLICATE
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT •
• AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS,
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 95, ACTS I945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
TITLE
4�:I.Ijlr -„
DOCUMENT CONTROL NO. 26534 CLERK - TREASURER
OFFICE COPY
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER I$ MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY CERTJF7 THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRI- G SUFFICIENTTO PAY Fr• THE ABOVE ORDER,