26715 Barnes & Thornburg 1 C 0 ty
INDIANA RETAIL TAX EXEMPT PAGE
1 ' CERTIFICATE NO.003120155 002 0
� �� � PURCHASE ORDER NUMBER
D1l /27)t)tj ) ^ 1 FEDERAL 5X 00 0972 EXEMPT 0. 61/6--
ONE CIVIC SQUARE /�J.`(',("J 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 �� 'I , TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
/1W Y30 — - DD0 PAYMENT 6l d00 • D Z>
n ^ • NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
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
THIS PROPRIAC• .SUFFICIENT.TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. , -�1 . }••C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY `_' S®.. )
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL r
SHIPPING LABELS. • �� / {
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE _
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. / '
CLERK-TREASURER t
DOCUMENT CONTROL NO 26715 OFFICE COPY
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