26713 Keller M<acaluso LLC C I. -A INDIANA RETAIL TAX EXEMPT PAGE
®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
piva q,,. ..• 4/ FEDERAL EXCISE TAX EXEMPT �/_ '7 / 3
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ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,AP
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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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: ,- :u4_= ( y
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PLEASE INVOICE IN DUPLICATE .
y DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
'v. Jl g /73e) ` -VO4eo PAYMENT #4/) "5/507. • De)
n • NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
G�L,'C//� NUMBER IS MADE A PART OF THE VOUCHERAND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
' SHIPPING INSTRUCT! NS • I HEREBY-CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THI e••RIATIONSUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. .4
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•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. .ORDERED BY -...ill1® —.1011111IN f
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE `�/ j� .1 f.J
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 26713 OFFICE COPY