25839 Salsbury BrothersCi. 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 NUMBER MUST APPEAR ON INVOICES, PIP
VOUCHER. DELIVERY MEMO. PACKING SLIP$.
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
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VENDOR
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CLANK ET
CONTRACT
PAYMENTTERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Send Invoice To:'
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• 0.0.0, SHIPMENTS CANNOT BE ACCEPTEG.
• 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.
PAYMENT
• MP 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 TTH/AT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRj411dTr STLRFICT(NT TO PAY FOR THE ABOVE ORDER.
ORDERED BY
TITLE
CLERK TREASURER
DOCUMENT CONTROL NO. OFFICE COPY