Free 00828.PDF - Indiana

A DVICE OF C HANGE IN PURCHASE ORDER
Issued by State of Indiana
State Form 828 (R 4 / 3 -00) Approved by State Board of Accounts - 1992
RECYCLED PAPER

This page number

O F

Total number of pages

VENDOR NOTICE: Match this document with the Purchase Order described below. Purchase Order / Change number

Purchase Order date Required delivery date I.D.O.A. identification number

P0 ACFund / Object / Center (use all 16 digits)

1

Original to vendor
Federal I.D. number of vendor Account / Project number

Name & address of vendor

Reporting code

Name of requesting agency / Approp. name

F OR AUDITO R O F S TATE
Verified by: Ship to: Funds available CONTRACT TERMS Changed by:

The contract terms and conditions contained in the original Purchase Order remain the same, except to the extent modified below.

Attached to original Purchase Order

Amended amount of Purchase Order

NOTICE: No price corrections will be permitted after issuance of this Advice of Change.
Contract Line I tem No.

QUANTITY ORDERED

UNIT

QUANTITY RECEIVED

ARTICLE and DESCRIPTION

UNIT PRICE

AMOUNT

NET INCREASE NET DECREASE

+ -

Signature of purchasing administrator

Typed name

Date signed

FUNDING ENCUMBERED BY THE AUDITOR OF STATE I certify that there is a sufficient unencumbered balance in the above account to cover the amount of the original Purchase Order as amended hereby, and that funds have been set aside for payment thereof.
Date signed

Indiana Department of Administration Authorized signature, Auditor of State Procurement Division 402 West Washington Street, Rm W468 Indianapolis, Indiana 46204 Telephone: (317) 232-3053

A DVICE OF C HANGE IN PURCHASE ORDER
Issued by State of Indiana
State Form 828 (R 4 / 3 -00) Approved by State Board of Accounts - 1992
RECYCLED PAPER

This page number

O F

Total number of pages

VENDOR NOTICE: Match this document with the Purchase Order described below. Purchase Order / Change number

Purchase Order date Required delivery date I.D.O.A. identification number

P0 ACFund / Object / Center (use all 16 digits)

2 Name & address of vendor

Auditor of State
Federal I.D. number of vendor Reporting code Account / Project number

Name of requesting agency / Approp. name

F OR AUDITO R O F S TATE
Verified by: Ship to: Funds available CONTRACT TERMS Changed by:

The contract terms and conditions contained in the original Purchase Order remain the same, except to the extent modified below.

Attached to original Purchase Order

Amended amount of Purchase Order

NOTICE: No price corrections will be permitted after issuance of this Advice of Change.
Contract Line I tem No.

QUANTITY ORDERED

UNIT

QUANTITY RECEIVED

ARTICLE and DESCRIPTION

UNIT PRICE

AMOUNT

NET INCREASE NET DECREASE

+ -

Signature of purchasing administrator

Typed name

Date signed

FUNDING ENCUMBERED BY THE AUDITOR OF STATE I certify that there is a sufficient unencumbered balance in the above account to cover the amount of the original Purchase Order as amended hereby, and that funds have been set aside for payment thereof.
Date signed

Indiana Department of Administration Authorized signature, Auditor of State Procurement Division 402 West Washington Street, Rm W468 Indianapolis, Indiana 46204 Telephone: (317) 232-3053

A DVICE OF C HANGE IN PURCHASE ORDER
Issued by State of Indiana
State Form 828 (R 4 / 3 -00) Approved by State Board of Accounts - 1992
RECYCLED PAPER

This page number

O F

Total number of pages

VENDOR NOTICE: Match this document with the Purchase Order described below. Purchase Order / Change number

Purchase Order date Required delivery date I.D.O.A. identification number

P0 ACFund / Object / Center (use all 16 digits)

3 Name & address of vendor

Requesting agency receiving room
Federal I.D. number of vendor Reporting code Account / Project number

Name of requesting agency / Approp. name

F OR AUDITO R O F S TATE
Verified by: Ship to: Funds available CONTRACT TERMS Changed by:

The contract terms and conditions contained in the original Purchase Order remain the same, except to the extent modified below.

Attached to original Purchase Order

Amended amount of Purchase Order

NOTICE: No price corrections will be permitted after issuance of this Advice of Change.
Contract Line I tem No.

QUANTITY ORDERED

UNIT

QUANTITY RECEIVED

ARTICLE and DESCRIPTION

UNIT PRICE

AMOUNT

NET INCREASE NET DECREASE

+ -

Signature of purchasing administrator

Typed name

Date signed

FUNDING ENCUMBERED BY THE AUDITOR OF STATE I certify that there is a sufficient unencumbered balance in the above account to cover the amount of the original Purchase Order as amended hereby, and that funds have been set aside for payment thereof.
Date signed

Indiana Department of Administration Authorized signature, Auditor of State Procurement Division 402 West Washington Street, Rm W468 Indianapolis, Indiana 46204 Telephone: (317) 232-3053

A DVICE OF C HANGE IN PURCHASE ORDER
Issued by State of Indiana
State Form 828 (R 4 / 3 -00) Approved by State Board of Accounts - 1992
RECYCLED PAPER

This page number

O F

Total number of pages

VENDOR NOTICE: Match this document with the Purchase Order described below. Purchase Order / Change number

Purchase Order date Required delivery date I.D.O.A. identification number

P0 ACFund / Object / Center (use all 16 digits)

4 Name & address of vendor

Requesting agency
Federal I.D. number of vendor Reporting code Account / Project number

Name of requesting agency / Approp. name

F OR AUDITO R O F S TATE
Verified by: Ship to: Funds available CONTRACT TERMS Changed by:

The contract terms and conditions contained in the original Purchase Order remain the same, except to the extent modified below.

Attached to original Purchase Order

Amended amount of Purchase Order

NOTICE: No price corrections will be permitted after issuance of this Advice of Change.
Contract Line I tem No.

QUANTITY ORDERED

UNIT

QUANTITY RECEIVED

ARTICLE and DESCRIPTION

UNIT PRICE

AMOUNT

NET INCREASE NET DECREASE

+ -

Signature of purchasing administrator

Typed name

Date signed

FUNDING ENCUMBERED BY THE AUDITOR OF STATE I certify that there is a sufficient unencumbered balance in the above account to cover the amount of the original Purchase Order as amended hereby, and that funds have been set aside for payment thereof.
Date signed

Indiana Department of Administration Authorized signature, Auditor of State Procurement Division 402 West Washington Street, Rm W468 Indianapolis, Indiana 46204 Telephone: (317) 232-3053

A DVICE OF C HANGE IN PURCHASE ORDER
Issued by State of Indiana
State Form 828 (R 4 / 3 -00) Approved by State Board of Accounts - 1992
RECYCLED PAPER

This page number

O F

Total number of pages

VENDOR NOTICE: Match this document with the Purchase Order described below. Purchase Order / Change number

Purchase Order date Required delivery date I.D.O.A. identification number

P0 ACFund / Object / Center (use all 16 digits)

5

Procurement division (department of Administration purchase order file)

Federal I.D. number of vendor Name & address of vendor Reporting code

Account / Project number

Name of requesting agency / Approp. name

F OR AUDITO R O F S TATE
Verified by: Ship to: Funds available CONTRACT TERMS Changed by:

The contract terms and conditions contained in the original Purchase Order remain the same, except to the extent modified below.

Attached to original Purchase Order

Amended amount of Purchase Order

NOTICE: No price corrections will be permitted after issuance of this Advice of Change.
Contract Line I tem No.

QUANTITY ORDERED

UNIT

QUANTITY RECEIVED

ARTICLE and DESCRIPTION

UNIT PRICE

AMOUNT

NET INCREASE NET DECREASE

+ -

Signature of purchasing administrator

Typed name

Date signed

FUNDING ENCUMBERED BY THE AUDITOR OF STATE I certify that there is a sufficient unencumbered balance in the above account to cover the amount of the original Purchase Order as amended hereby, and that funds have been set aside for payment thereof.
Date signed

Indiana Department of Administration Authorized signature, Auditor of State Procurement Division 402 West Washington Street, Rm W468 Indianapolis, Indiana 46204 Telephone: (317) 232-3053