26596 John Molitor ityr �° �} INDIANA RETAIL TAX EXEMPT PAGE
of C armel. CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT /13--q
35-60000972 l� /
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
'URCHAS ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: L s ,�
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1 v i ri'L I, $ , (7-7)-0
C' Q, d3PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHy HAS THE PROPER SWORN AFF'AVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HER::CERTIFY THAT TH -E IS AN U. BLIGATED BALANCE IN
•SHIP REPAID.
THI OPRIATIO' SUFV'TENT TO•• FOR THE ABOVE ORDER.
4•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL -.,�,
SHIPPING LABELS. czei„,„z„,6,,,,,,, i,...,
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE ,. /
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. d
CLERK-TREASURER
DOCUMENT CONTROL NO. 2 6 5 9 6 VENDOR COPY