State Form 45450 - Advice Of Change Of Purchase Order

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INDIANA DEPARTMENT OF TRANSPORTATION
State Form 45450 (R2/8-00)
INDIANAPOLIS INDIANA
Page number
Total number of pages
Approved by State Board of Accounts – 2000 Approved by Auditor of State 2000
ADVICE OF CHANGE OF PURCHASE ORDER
OF
Vendor’s Name
and
Purchase Order number
Change Number
Address
AC
AC
Fund
Object
Center
Requisition number
Remit to:
Name and number or requesting agency
Date of Order
I N D O T -
I N D O T -
800
800
Requested by and bill to:
REMIT TO FED. I.D.#
1099
Ship to:
CODE
ESCROW CODE:
CONTRACT NUMBER:
PCN NO:
Contract
Amount
Job/Project
Prty
Fund
Agcy
Orgn
Appr. Unit
Actv.
Obj.
I/D
Reference Document
Ln
CD
Number
Ln
Number
01
RQ
02
RQ
03
RQ
TO THE VENDOR The Purchase Order described above is hereby amended as set forth below.
ORIGINAL AMOUNT
ADJUSTED AMOUNT
TOTAL
TOTAL
Authorizing signature
Date (month, day, year)
NET INCREASE
NET DECREASE
ISSUED FOR INDIANA DEPARTMENT OF TRANSPORTATION
I certify there is 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 the payment thereof.
Procurement Supervisor, Department of Transportation
Director of Auditing
st
nd
rd
th
th
th
.. 1
copy (White) – Vendor; 2
copy (Blue) – Auditor of State; 3
copy (Canary) - A & C; 4
copy (Goldenrod) – District/Division; 5
copy (Pink); 6
copy (Green)

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