26665 West Payment Center CiGty ,Jlr®J� /�\�/arm.e INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
DL 7A T�LJ ) V / 1)-t FEDERAL 5-0000972 EXEMPT /
G ONE CIVIC SQUARE G• 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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
) /
VENDOR " ) J""" ` SHIP
� �/y�V TO
ea)Cia ; .--4- loo/ 9 - / 1_7 2..
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
4
' P / 4 ' 1 4
1 ,75.37,00
. `i_6, 3 M37
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Send Invoice To: jel
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT �y AMOUNT
� .cu f�g0 //44 - l0g44OD PAYMENT / SS.O6
/, / • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
Or 1 NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
�I 66/,-,71/11-,---Q-----' VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS AP I9, ICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY -
0, ▪PURCHASE ORDER NUMBER MUST APPEAR ON ALL
_
SHIPPING LABELS. '
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE / I, i
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V 4111 ,
CLERK-TREASURER
DOCUMENT CONTROL NO. 26665 OFFICE COPY .