31279 Howard Wickersham (Revised) C0 INDIANA RETAIL TAX EXEMPT PAGE
ity of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
INDIANA THIS NUMBER MUST APPEAR ON INVOICES,AP
ONE CIVIC A43E VOUCHER, DEUVERY MEMO. PACKING SLIPS.
CARMEL, SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO DESCRIPTION
1/21/2014
Howard Wickersham Street Department
SHIP
VENDOR 3400 W. 131st Street
TO
14838 Rosebud Dr. Carmel, IN 46074-
Noblesville, IN 46060- (317)733-2001
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
1
QUANTITY `UNIT OF MEASURE DESCRIPTION UNIT PRICE V EXTENSION
1 Each
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Send Invoice To: .s--- ,` ', Pi-1 , , I %'
Street Department
3400 W.131st Street
Carmel,IN 46074- PLEASE INVOICE IN DUPLICATE
_ DEPARTMENT ACCOUNT PROJECT [ PROJECT ACCOUNT AMOUNT n� ,
PAYMENT ; 0 I`
Carmel Street Dept. 42-365.00 • 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 PROP R SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY T IEREISANUNOBLIGATED BALANCE IN
THIS APPROPRIATI TTO PAY FOR THE OVEORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY //
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL A \ //A -
SHIPPING LABELS. TITLE �
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 312 79 VENDOR COPY