26547 Crossroad EngineersCi of Carmel
. ONE,CIVIC SQUARE
• CARMEL, INDIANA 419092-2564
r 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
2 CoS-G �-
THIS NUMBER MUST APPEAR ON INVOICES. AR
VOUCHER, DELIVERY MEMO. PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REOUIRED
REQUISITION 'NO.
VENDOR NO-
DESCRIPTION
VENDOR Cvocza ('to
4 \OQVS
TO
�>`Th O� E- • JAQCY 1 A
OONFIFMATION BLANKET CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
LINK OF MEASURE
DESCRIPTION
UNIT PRICE '
EXTENSION
Send invoice To:
,SSA A Si
•"rev
Orcit N
PLEASE INVOICE IN DUPLICATE
DEPARTMENT
•
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26547
ORDERED BY
TITLE
PAYMENT
• NP VOUCHER CANNOT DE 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 CERTgO THAT THERE IS AN UNOBLIGATED BALANCE IN
P O
THIS APPRON P FICIENT `O Y FOFl THE ABOVE ORDER.
CLERK - TREASURER
OFFICE COPY