26667Xerox Corporation CltY ®f� Carmel INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
EPPle riV�7 / FEDERAL 5-600 E0972 EXEMPT a ./
• �/ ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/I
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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SHIP
VENDOR 7)..W114-n)W.
' 0 .5-56r_5"J5-.�OS TO
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CONFIRMATION BLANKET CONTRACT U T TERMS FREIGHT
QUANTITY UNIT OF MEASURE I DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: ..
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
'j040 //V) °V3-° W/O° PAYMENT 7 01/yfi
'// calek A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.Ne 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
•SHIP REPAID.
THI •'- e CIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ■il
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE l i. _ �I�/� - L,��
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. /- v dirr.
DOCUMENT CONTROL NO. 26666 CLERK-TREASURER
OFFICE COPY