26540 Clark DietzCity 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 ROARER MUST APPEAR ON INVOICES, AIP
VOUCIIER. DELIVERY MEMO. PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
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VENDOR
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SHIP The >4. o
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CCUWERMAtION
BLANKET
CONTRACT
PAYMENT TERMS
• FREIGHT
QUANTITY UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice Tor
DEPARTMENT
t4
2o2 -4o\
PLEASE INVOICE IN DUPLICATE
'• ACCOUNT
PROJECT 1 PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.O. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CI'IAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. '26540
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MA E A FART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER 1;448/THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY TI THAT THERE IS AN UNORLIGATED BALANCE IN
THIS AFPg a P NNLtl FICIENT TO PA OP 1FI♦,E ABOVE ORDER.
AIL