26545 Crossroad EngineersCi
of Carmell
ONE CIVIC SQUARE
CARMEL, INDIANA 45032 -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 SUPS,
SHIPPING LABELS AND ANY CORRESPONDENCE,
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO,
VENDOR NO.
DESCRIPTION
CYO &COL ��SI�IA VS
VENDOR
SHIP �'�- UC “InQpiLIL✓l✓1%
' TO
OONFIRMATPON
BLANKET ,
CONTRACT
PAYMENT TERMS
FREIGHT .
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
202- c1oj •
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.D D_ SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1995
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26545
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
AMOUNT
PAYMENT
• AIP VOUCHER CANNOT EE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER 15 MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THA THESE IS AN UNOELIGATED BALANCE IN
THIS APPROPRIATION IS r ICI T- TO PAY FOR THE ARLIE ORDER.