26478 Hewlett Packard City0 '( "° INDIANA RETAIL TAX EXEMPT PAGE
®-I C armel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 4 V
35-60000972 l{�
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/
, P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION , •'-' „'=-.
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
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QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: j,/�4 irl• a I /4,.j4
City G 17 C fir r e-- 1W 4q
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• NP 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.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN/UNOBLIGATED BALANCE IN m•q
• SHIP REPAID. THIS' 'P/RO�P�RIAT ON S' "FIICIENT TC'PAY FOR THE ABOVE ORDER.-:. , " '''
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY �J e.... J `` # .0.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ' "°
SHIPPING LABELS. v '� ad-----cn--L-7(A-i '''�// ///•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE -e_L_. � 4
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
�y CLERK-TREASURER
DOCUMENT CONTROL NO. I A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT •
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
• materials or services itemized thereon for
• which charge is made were ordered and
received except
•
•
•
20
•
Signature
•
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund