26468 Rundell ErnstbergerCi
nnel
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
0104 40 Er
THIS NUMBER MUST APPEAR ON INVOICES, A•P
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURR'CHASECCORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR
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TO
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CONFIRMA TION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UUFi OF MEASUHE
DESCRIPTION
UNIT PRICE_
ENTERS ION
Send Invoice To:
Lds# 41. 5c2&4)4L -.f
i u19#V7,l ?Ci„,4°7
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3322. AirAc, .cL
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PLEASE INVOICE IN DUPLICATE
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DEPARTMENT
ACCOUNT
PROJECT
1 PROJECT ACCOUNT 1
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• 0.0.0. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLfANCE WITH CHAPTER 99. ACTS 1995
AND ACTS AMENDATORY THEREOF AND SUPPI .EMENTTHERETO.
DOCUMENT CONTROL NO. 26468
ORDERED BY
TITLE
CLERK - TREASURER
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER 15 MADE PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• 1 HE3EPY CERTIFY THAT INERT S AN UNOELICATEF BALANCE IN
THI APPROPRIATION SUFFICIE.NT TO PAY FOR THE ABOVE ORDER.
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A.P.V. COPY - SIGN AND RETURN TO CLERK'S *OFFICE