26551 Crossroad Engineers wei
Cd0 INDIANA RETAIL TAX EXEMPT PAGE «,1414L.,.."`�'.., -
of C �1.�arm( CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT ���--
35-60000972 J
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
VENDOR CYO(jc-i(OC . ei/k 1 S SHIP - 0c E-Yl k V■Q-9L-✓1 ►/
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: 6✓I C _
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PLEASE INVOICE IN DUPLICATE 2t1 —C-Oci
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 CERTIFWATT( H@RE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATIOF IIFFICIENT TO PAY FOR THEABOVE ORDER.
•SHIP REPAID. ✓
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY 4 /,
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL r.4"(....L.........
SHIPPING LABELS. /
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 1 21
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
6 5 5 CLERK-TREASURER
DOCUMENT CONTROL NO. OFFICE COPY