26712 Xerox 0 INDIANA RETAIL TAX EXEMPT PAGE
City or sane l CERTIFICATE NO.003120155 002.0
��// PURCHASE ORDER NUMBER
D O -P/20! U F k)(4,6 FEDERAL EXCISE TAX EXEMPT
35-60000972 J6, 1.1--
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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VENDOR 107.2471
SHIP
F/ : TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION '/�jf/ UNIT PRICE EXTENSION
q
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5.
Send,Invoice To: 4;/,/ 4:/ ( ;
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
g //$U 'y.3�O''''/534°y PAYMENT 70.2/ A/Ol, �OC�
66 I • A/P VOUCHER CANNOT'BE APPROVED FOR PAYMENT..UNLESS THE P.O.
l y NUMBER IS MADE A PART OFIT,HE.VOUCHER AND EVERY.INVOICE AND
VOUCHER HAS THE.PROPER1SWORNAFFIDAVITATTACHED. .1
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
77)
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 'TITLE ,„ 'i4? Z`L/K, G-1
' AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
�j CLERK-TREASURER
DOCUMENT CONTROL NO. �• OFFICE COPY
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