29276 Indiana Department of Workforce Development it 0 Carmel CEINDIANA
NOL 031201(55 02 0 PARE
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 29276
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP
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
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/14/12 N/A /416 500 Unemployment Claims
Indiana Department of Workforce Development AO ,r,C TT T
VENDOR 10 No/r-t- S t e,4Ve, /04' SHIP ' DEC 17 2012
l nd ��/i j IN -[,�J i oq- TO 1
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION I UNIT PRICE 1 EXTENSION
1 EA Projected 2012-Related Unemployment Claims $30,420.00 $30,420.00
Send Invoice To
PLEASE INVOICE IN DUPLICATE $30,420.00
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1125-1-01-4110000-Full Time Regular PAYMENT
• A/P VOUCHER CANNOT BE APPROVID FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWOP)AFFIDAVIT ATTACKED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT 10 PAY FOR THE ABOVE ORDER.
•SHIP REPAID. �/
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. Michael Klitzing - DK
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY a ��..,�\I .\i'.. 12._� �� I Z,__
SHIPPING LABELS. /
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE'"1,0 /ad 11j y/1/✓
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
29276 CLERK-TREASURER
DOCUMENT CONTROL NO. VENDOIR COPY