26544 American StructurepointCity of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA46032 -2594
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, NP
VOUCHER, DELIVERY MEMO, PACKING SUPS,
SHIPPING LABELS AND ANV CORRESPONDENCE,
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
VENDOR
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SHIP' O}- 6� _ f1 A04. rl ✓�.
TO ``
• CONFFlF MAT ION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
ODANTITY
UNIT CF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
-2.1009 +r2�
DEPARTMENT •
ACCOUNT
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 99, ACTS 1945 .
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO
DOCUMENT CONTROL NO. 26544
PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
ORDERED BY
TITLE
CLERK- TREASURER
OFFICE COPY
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PC.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED -
I HEREBY CERTIFY THATHERE IS AN UNOBLIGATEO BALANCE IN
THIS APPROPRIATIO S ICIEN TO PAY FOR THE ABOVE ORDER.