26543 United ConsultingCi of Gemmel
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
112-SI12
11( 1 \-1lQS Cc A _uWWS
VENDOR
SHIP \ - \?C' . oC L.X `51 0-:.v 1 ✓1
TO
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE,
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
brc
PLEASE INVOICE IN DUPLICATE
-zooLo 6ovid
DEPARTMENT
ACCOUNT
SHIPPING INSTRUCTIONS
PROJECT
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED. .-
• PURCHASE ORDER NUMBER MUST APPEAR ON
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE VIITH CHAPTER 99. ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26543
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PROJECT ACCOUNT
PAYMENT
• A'P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATIONBUFFICIENT TO PAY FOR T E ABOVE ORDER.
AMOUNT