26668 Douglas C. Haney ®J� Carmel INDIANA RETAIL TAX EXEMPT PAGE
1111 ,J,J�f CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
Defig.gre � a / FEDERAL EXCISE TAX EXEMPT lJ/.�/ I_ /`� 35-60000972 0 6 6
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 •
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. ' DESCRIPTION
•
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VENDOR '0' %` /" I SHIP
IF
TO
CONFIRMATION BLANKET CONTRACT • PAYMENT TERMS' FREIGHT •
QUANTITY UNIT OF MEASURE DESCRIPTION . • UNIT PRICE EXTENSION
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Send Invoice To: rd
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PLEASE INVOICE IN DUPLICATE
,�� DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
?Cti,60 //g0 • 1/30' '_.3 00°Z_ PAYMENT /� / 3k
' et,& ,et?- tt.7.1G • A/P VOUCHER CANNOT BE APPROVED FOR PA MENT UNLESS THE P.O.
Ivi 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.
• THIS-APPRQFFTIAIIUN SUP - , TO PAY •; E ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. •ORDERED BY �_- •
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. '
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•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE ,,,FFF-----���
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 2 6 6 6 0 CLERK OFFICE COPE YR v
COPY