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Payee: <br />ACC-QU�-,.F,ITS VOUCHER <br />Department: Public Works — Engineeri <br />Mr. Al X. Zielinski <br />Mrs. Nancy A. Zielinski <br />1302 East Jackson Road <br />South Bend, Indiana 46614 <br />f <br />Account Number: <br />Vendor Number: <br />Project Number: <br />645--0623--665-66-11 <br />106--087 <br />Phone: 574.235.9251 <br />Federal Excise Tax Exemption <br />35-6001201 <br />ie ie r. a4xarr eE Sc it aF ie se �r ie it �k:E�'e ie is ie ie hdc ie xa'c �t :k yl-ie �c �'c <br />Indiana State Tax Exemption <br />6103-502-538-0-011 <br />Purchase Order No. <br />Date Due: <br />An invoice or bill to be properly itemized must show: kind of service, where performed, dates service <br />rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. <br />I hereby certify that the attached invoice(s), or bill(s), is(are) true and correct and that the materials <br />or services thereon for which charge is made were ordered and received except: <br />-5/2- 7 <br />Signature (Department Head or Designee Title <br />I hereby certify that the attached invoice(s), or bill(s) is(are) true and correct and I have audited <br />same in accordance with IC 5-11-10-1.6. <br />, 20 <br />for Controller's Office <br />Approved by State Board of Accounts for City of South Bend - 2000" <br />