26730 Midwest Toxicology INDIANA RETAIL TAX EXEMPT PAGE ' *� 1
®f Carmel l CERTIFICATE NO.003120155 002 0 1
•
��1� //// PURCHASE ORDER NUMBER
• FEDERAL EXCISE TAX EXEMPT z - 3 Q
35-60000972
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
)400?2_
(f1,, ,,rQ.sk )*..,A(1Cv C% -( jr Cam,r,Mn�\
) Y SHIP r1� = i-t.,v�,�.J ' 1�e5,vv'ces
VENDOR ..?0..3 4- . �SL,1i -+..a
TO
S l Z C,ti L
tG vG�l.J)t f 1 v 2�'1 CGS-WIC) .Y) l a`1 3�
1
.
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
)e-51 1' 170c)..„, ,
Oil CA.,6;)--4W
,4 ,,,,,,..,,,....°A
; „ ,-.„( --*
ill,
i,,,,,, 0.4t,
0. rio A epo .
,,4 isly*,., 11,111111k
tNi4P4 i°-/- \
,,,,„, v) t; ,�, . .
,,4 ..- ,.,5,,) 4
o `` -, ...c0 '
4.`"'�`
' 1� C m r
Send Invoice To: ✓~ 11i
I „F
•
PLEASE INVOICE IN DUPLICATE
. DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
.)ZaJ --�M 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
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• , SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE BOVE ORDER.
•SHIP REPAID: /'�
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. / !'
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY `��-
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND.SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26730 -CLERK TREASURER
- -,O,FFICE.COPY