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181411 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO CARMEL, INDIANA 46032 Po M I89020 CHECK AMOUNT: $3,223.03 i+, o �.�o� DES MOINES IA 50368 -9020 CHECK NUMBER: 181411 CHECK DATE: 1/13/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4232100 603530120005 79.95 6035301200050860 1120 4238000 603530120005 89.99 6035301200050860 2201 4237000 603530120005 445.22 6035301200050860 2201 4356001 603530120005 2,607.87 6035301200050860 m—_,; Viri 'MUM' BUSINESS 0000341 Y A CCOUNT SUMMA 6035 S01200051:01360 3 s i r :.A wt xk,..:.,.k-e r, -4,6 r :,,d,,r.,..i .fi3y>r3:.� r .,..,A,a a „r e t. i'� a�'•.,y` §9.6 ":s w, r e a„ x >r...:;,.�. ,e„c ..<xw r.. 4 «.fit.. a,.�.n..;<i <,,s ss xh. 7�: Previous Balance 1 ,323.27 Closing Date 12/18/09 Payments 1 ,390.87 Next Closing Date 01/20/10 CARMEL STREET DEPT Credits 0.00 Payment Due Date 01/12/10 CINDY Purchases 3,223.06 3400 W 131ST ST Debits 0.00 Current Due 3,155.46 WESTFIELD, IN 46074 8267 FINANCE CHARGES 4 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 3 ,155.46 Credit Available 2 ,094 New Balance 4 3,155.46 CURRENT ACTIVITY v 7 i �y v x .t s"3 a A t> K °t a x ,t F,ji¢sa. T ransaCI.y∎! a l L O y 4 :iii x `4 s c a Z "i .b. 4- v a f f t II M ;,T, A yr. ''tpA-B H t.�s�r i V k :i t a.1'1,,, r ..,,;∎SPAt:1' x ,.144._ >g 3 'y a ;;O:. kj-f r i�' ,..4::wsn i 3 DEC 10 GOODS AND SERVICES NOBLESVILLE IN 1,776.00 DEC 14 GOODS AND SERVICES WESTFIELD IN 47.98 TOTAL 6035301200074795 $1,823.98 NOV 24 GOODS AND SERVICES WESTFIELD IN 82.81E DEC 1 GOODS AND SERVICES WESTFIELD IN 79.98 DEC 1 GOODS AND SERVICES WESTFIELD IN 89.99J'- TOTAL 6035301200074803 $252.83 DEC 3 GOODS AND SERVICES WESTFIELD IN 164.98 TOTAL 6035301202895908 $164.98 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Billing PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 30 0.00 0.00 .00000 29 0.00 This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1-800-559-8232 FAX NUMBER 1 -801- 779 -7425 IHAUIUH SUN-PLY UHLUII FLAN AL(;OUN1:60353O12UDU5UtitiU r Vrust DEPT.30- 1200050860 JEFF STEWART SUPPLY Cg z PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000344 Payment Due Date: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP TO INVOICE: 431000982741010 431000982739010 Purchase Order: Purchase Order: FIREDEPTBOBV FIREDEPTBOBV AMOUNT DUE: 89.99 AMOUNT DUE: 79.98 Store: 574000431 INVOICE DATE: 12/01 /09 Store. 574000431 INVOICE DATE: 12/01 /09 JS PARTS WASHER 20GA 5893999 1.00 89.99 89.99 PARTS WASHER CLEANER 5G 3893915 1.00 39.99 39.99 PARTS WASHER CLEANER 5G 3895915 1.00 59.99 39.99 SUBTOTAL 89.99 TAX 0.00 SUBTOTAL 79.18 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 89.99 TOTAL 79.98 V.,) C. SHIP TO: INVOICE: SHIP To: INVOICE: 431000983082010 624200005613010 Purchase Order: SHOP AMOUNT DUE: 164.98 AMOUNT DUE: 79.99 Store: 574000431 INVOICE DATE: 12/03 /09 Store. 574000624 INVOICE DATE: 11/23 /09 JKT ARCTIC 48 BN CT63 6310411 1,00 64.99 84.99 JKT INS SOSTN XLT MS CT 7037383 1.00 79.99 79.99 BIB CRHT INSLTO BR 4603 6311653 1.00 79.99 79.99 SUBTOTAL 79.99 SUBTOTAL 164.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 79.99 TOTAL 164.98 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 REMIT TSC BUSINESS ACCOUNT T TRACTOR® PAYMENTS ONLY TO: SC TRACTOR SUPPLY COMPANY SUp1)LYC2 P.O. Box 689020 Tractor' Surp1y Company C2 Des Moines, IA 50368 18360 U.S. 31 tdor th TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wes tf ie1d, IN 46074 (31 r) 667 -3505 (6035 301# NAME CARMEL S r I:EE r DEPT 3400 W 131ST ST WESTFIELD IN 460746267 ADDRESS (317) 73 CITY STATE ZIP PHONE 431 431000187 2 962739 12/01/2009 05:13pm CUSTOMER TO COMPLETE 3693915 PARTS WASHER CLEANER 1,00 2 39.99 39.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from 3893915 PARTS WASHER CLEANER compliance with the agricultural g p Y p 1 ,00 e 39,99 39,99 NT com p g payment of sales and use tax on tangible personal Government As enr.ies sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of Subtotal 79.96 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 7,00.% Tax 0.00 Exemption Statement at right and resale and /or uses the farm machinery, equipment or the applicable statement of the Y Total 79.98 pective state printed on the other agricultural production items purchased free of TSC Card 79,93 res reverse side t this form. tax, as defined by state law, and as indicated below. Acc to s r> s 3 s 3 s s z s 3 s 4803 Auth0:001817 1ief':01 1 61 3051 2 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they PO s: FIRE DEPT BOB V STATE: understand they may be liable for payment of all taxes Chance 0,00 (REQUIRED) due on the purchase price for the goods as allowed by Cash Back (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Y Buyer acknowiedse:s the receipt of a comPl.e PURCHASER•IS ENGAGED IN: (REQUIRED) t, rci Resale Under penalty of perjury, signee swears the Lore of this sales slip and the Purch:lse o Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation the described merchandise shall be in 0 Agricultural Production of exemption will cause the purchaser to be subject to accordance with the Cardholder Asrecment, DairyProduction penalty.and /or. other provisions as�allowed understate 0 Livestock Production t Flonc /Aquaculture Production law O Other 1 Sisnature: ITEMS PURCHASED WILL BE USED •FOR: (REQUIRED) J I ,,1 r it a ,i O' Farm Machinery /R epair Paris O. •Government Agency (Entity r M 't yi'i I F. i o Liv In)estibles or In)ectibles Exempt Org 1 4 333 3 t 3 8 33333 3 fi 3 3 8 t 333 t: t t .S -3 3" k 3 2 333: 4, I NC only DOT and US Governmentareexempt, �i t k 3333X3 3331 EY33331333333333 '!;.124.17 ertilizer /Agnchemicals 1 14 1 -N s i� Resale (Sales Tax Permit r r r r` )`;t Call 8370 °966 0734 within l i daY,5 to C onsumed in Pr KS t+ r" t; cotnp e a' be c.rtered .t a .'r ii ;IR S1I 9:. i 7 x ..t F, Ingredient or Component Parts (KS) ;x 7 r; r 4 0:.. t b ,kl r s `>r a y 4 I x ur I nlonttvl.Y dt'�Wln9 for a r_han �tn win a. u. 4 ::.c a Y 1 `i 3 14 Othert t aiiN tl i SFIOPPii)9 SPIe r i 1� ns' i ll (Awar. ued a s G Card) NU `Pt1RCHASE 1;o t wit)1' 1 1 ?1.-.r....,E'l i- ii C c ER SIGN URE: (REQUIRED) 'MGR. APPROVAL f t USE SHADED AREA ONLY WHEN REGISTER IS INOPERATNE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE QUANTITY ITEM NUMBER TAX DESCRIPTION SNIT PRICE Form No. 99 -00401 (12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TO: R® TRACTOR SUPPLY COMPANY SUPPLY C P.O. Box 689020 T Sueply Company Des Moines, IA 50368 10160 fl 5 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit f3] it Account Number We (31 stfield.I 16074 7) 867••3-05 (6035 301# NAME CARMEL STI E:cr DEPT 3400 W 131ST ST WESTFIELD IN 460748267 ADDRESS (3]7) 733-20411 CITY STATE ZIP PHONE 431 431 0001 07 2 982741 12/01 /2009 05:151 CUSTOMER TO COMPLETE :1093999 „IS PARTS WASHER 20GA 1.00 e 49,99 99.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res. p'r'ice: 79,79 The undersigned certifies The undersigned party certifies their exemption from Government Asenries compliance with the agricultural payment of sales and use tax on tangible personal Subtutal 89.99 sales tax exemption law of the state property as indicated below and /or purchaser is ?.0by •f indicated below and understands EX 0'9 and agrees with the General engaged in the business of agricultural production of Total 89.99 and food or fiber, horticulture, aquaculture of floriculture for CSC Card 89, Exemption Statement t the right ee applicable statement of the resale and /or uses the farm machinery, equipment or Acctt:ttttttlttl:xt4803 r respective state printed on the other agricultural production items purchased free of IUtht:001 967 Ref t�:0 1 1 61 45961 reverse side of this form. tax, as defined by state law, and as indicated below. 0 1r :FIRE DEPT BOB V Cho..nse 0.00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they casf1 1'5:11: tc STATE, understand they may be liable for payment of all taxes —4 (REQUIRED) due on the purchase price for the goods as allowed by Buvtr i:;cknrtaledses the re•ceie t of a ci; :wle (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in q j COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. COPY of this sates slip aad the Purchase o PURCHASER IS ENGAGED IN: {REQUIRED) f Resale Under penalty of perjury, signee swears the t described merchandise shall be in Government information on this statement is true and correct in accordance with the cardholder A Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to' Dairy Production penalty and /or other prov as allowed under state Si inatitre; Livestock Production Floriculture /Aquaculture Production law Other: ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) Farm Machinery/Repair Parts 0. Government Agency (Entity t t t 3 t x# t.t s t t t t t t t 3 x t t'3 t t[ 8 8 r ,t t t. Livestock lnjestibles or injectibles Exempt'Organization (Entity Call 000t-968-0734 within 7 days to NC: only DOT and US Government are exempt 0 Fertilizer /Agrichemioals coo'le ii- a stirveY and' be entered in a Consumed in Production (KS) .Resale (Sales Tax Permit# monthly iieawins for a- chance to win a to' •2500 shOrp ins '_tP 1 ee.. Ingredient or Component Parts (KS) 1 (tlward as G t Card N() f WCHASI Other. or,: SURVEY NECESSARY Ends 9/-30/.10., 1111: c sttxi�tttxTa #t.tttassttat$st ttst C .•MER SIG ATU E:(REQUIRED) ,MGR A PPROVAL C� I r 3 i 7 USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C `OISCOVER 'TSC CHARGE ACCOUNT NO v' d CHG. k EXCH.'„ DATE t�2 QUANTITY ITEM NUMBER NON DESCRIPTION YNIT PRICE TAX=: Form No. 99 -00401 {12/08) CUSTOMER ORIGINAL VOUCHER NO. WARRANT NO. ALLOWED 20 Tractor Supply IN SUM OF$ P.O. Box 9020 Des Moines, IA 50368 -9020 $169.97 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 43100098273901C 42- 321.00 $79.98 I hereby certify that the attached invoice(s), or 1120 43100098274101C 42-380.00 $89.99 bill(s) is (are) true and correct and that the 1120 42- 380.00 materials or services itemized thereon for which charge is made were ordered and received except JAN 1 1 2010 (I 111.6.-... 2 "c i 4 J Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 431000982739010 $79.98 43100098274101C $89.99 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer page 1 of 7 TX 7 D 13 00000� 4 iYiV m. °e VSUPPLYCT BUSINESS ACCOUNT 0000341 Noweema AG: UNT SUIIAINARY 6tD35 301 X0105 086 9 A Ika._;:: Previous Balance 1,323.27 Closing Date 12/18/09 Payments 1 ,390.87 Next Closing Date 01/20/10 CARMEL STREET DEPT Credits 0.00 Payment Due Dale 01/12/10 CINDY Purchases 3 ,223.06 3400 W 131ST ST Debits 0.00 Current Due 3,155.46 WESTFIELD, IN 46074 8267 FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 3,155.46 Credit Available 2,094 New Balance 4 3,155.46 CURRENT ACTIVITY Tiansactton t t ee Lacatieni" 1, t g E_ �'k f� �A1'1i k Date V i g [lsscnptl Bill _"i €r y t.: 4_ ki DEC 10 GOODS AND SERVICES NOBLESVILLE IN 1,776.00' DEC 1 GOODS AND SERVICES WESTFIELD IN 47.98 TOTAL 6035301200074795 -$1,823.98 NOV 24 GOODS AND SERVICES WESTFIELD IN 82.8& DEC 1 GOODS AND SERVICES WESTFIELD IN 79.98 DEC 1 GOODS AND SERVICES WESTFIELD IN 89.99 TOTAL 6035301200074803 $252.83 DEC 3 GOODS AND SERVICES WESTFIELD IN 164.98 TOTAL 6035301202895908 $164.98 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Billing PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 30 0.00 0.03 .00000 29 0.00 This Account Issued by Citibank (South Dakota), NI A. CUSTOMER SERVICE 1- 800- 559 -8232 FAX NUMBER 1 -601- 779 -7425 page 2 of 7 Tx 7 D 190000900 ®S� y am/ BUSINESS ACCOUNT 0000342 CURRENT ACTIVITY Transact(on f� x Lo�cationl" k p Date t3# a .t DesGnOion Am NOV 23 GOODS AND SERVICES NOBLESVILLE IN 79.99' TOTAL 6035301202895916 $79.99 DEC 2 GOODS AND SERVICES WESTFIELD IN 15.49' TOTAL 6035301202895973 $15.49 DEC 3 GOODS AND SERVICES NOBLESVILLE IN 9.37 TOTAL 6035301202896070 $9.37 NOV 23 GOODS AND SERVICES WESTFIELD IN 139.98 DEC 4 GOODS AND SERVICES WESTFIELD IN 59.99 TOTAL 6035301202896096 $199.97 NOV 23 GOODS AND SERVICES NOBLESVILLE IN 194.97 TOTAL 6035301202896104 $194.97 DEC 17 GOODS AND SERVICES WESTFIELD IN 144.5• TOTAL 6035301202896138 $144.57 NOV 25 GOODS AND SERVICES NOBLESVILLE IN 143.98' DEC 1 GOODS AND SERVICES WESTFIELD IN 82.99- TOTAL 6035301202896153 $226.97 NOV 30 GOODS AND SERVICES WESTFIELD IN 109.94- TOTAL 6035301202896161 $109.94 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS NOV 19 PAYMENT REF P919400A40A1BD80E 603.57 DEC 18 PAYMENT REF P919400B009N1JVBD 787.30 This account is subject to the Alternate Balance Subject to Finance Charge Calculation Method. See back for details. Remit To: Bill To: page 3 of 7 TRACTOR SUPPLY CREDIT'PLAN ACCOUNT: 6035301200050860 TRACTOR DEPT.30 1200050860 RON WILLIAMS SUPPLY Cr PO BOX 689020 211 2ND ST SW BUSINESS ACCOUN DES MOINES IA 50368 -9020 0000343 Payment Due Dale: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN sor SHIP 70: INVOICE: SHIP To INVOICE: 624200009080016 431000986288010 Purchase Order: 239 AMOUNT DUE: 1,776.00 AMOUNT DUE: 47.98 Store: 574000624 INVOICE DATE: 12/10 /09 Store: 574000431 INVOICE DATE: 12/14 /09 SPECIAL ORDER PAYMENT 624210046 1.00 1,776.00 1,776.00 SWTSHIRT XL HOOD NV BNC 7121085 1.00 23.99 23.99 SWTSHIRT XL HOOD NV BNC 7121085 1.00 23.99 23.99 SUBTOTAL 1,776.00 TAX 0.00 SUBTOTAL 47.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 1,776.00 TOTAL 47.98 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000979060010 431000980740010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 23.98 AMOUNT DUE: 82.86 Store: 574000431 INVOICE DATE: 11/17 /09 Store: 574000431 INVOICE DATE: 11/24 /09 BLOW GUN W EXTN NOZZLE 3314262 1.00 11.99 11.99 LOCKPIN SW 1/4 X 2 1/2 1833003 1.00 2.49 2.49 BLOW GUN 2FT EXTN 3324160 1.00 11.99 11.99 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.49 2.49 LOCKPIN SW 1/4 X 2 1/2 1833553 1 -00 2.49 2.49 SUBTOTAL 23.98 LOCKPIN SW 1/4 X 2 1/2 1853553 1 -00 2.49 2.49 TAX 0.00 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.49 2.49 SHIPPING 0.00 LOCKPIN SW 1/4 X 2 1/2 1833553 1 -00 2.49 2.49 TSC HITCH PIN 1/204I4 3 0268666 1.00 3.99 3.99 TOTAL 23.48 TSC HITCH PIN 1 /264I4 3 0268666 1.00 3.99 S.99 TSC HITCH PIN 1 /2X4IN 3 0260666 1.00 3.99 3.99 TSC HITCH PIN 1 /2X4IN 3 0268666 1.00 3.99 3.99 F8R PINBCLIP 5/81N BKPV 1891137 1.00 4.99 4.99 F8R PINBCLIP 5 /81N BKPV 1891137 1.00 4.99 4.99 F8R PINBCLIP 5 /8IN BKPV 1891137 1.00 4.99 4.99 G8 GALV AND COTTERPIN B 3568887 10.60 3.49 36.99 SUBTOTAL 82.86 TAX 0.00 SHIPPING 0.00 TOTAL 82.86 Please Direct Inquiries to: Phone: 800-559-8232 Fax: 801- 779 -7425 Remit To: Bill To: page 4 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TRACIOR DEPT.30 1200050860 JEFF STEWART SUPPLY C Q =o PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000344 o Payment Due Date: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO INVOICE: 431000982741010 431000982739010 Purchase Order: Purchase Order: FIREDEPTBOBV FIREDEPTBOBV AMOUNT DUE: 89.99 AMOUNT DUE 79.98 Store: 574000431 INVOICE DAT 12/01 /09 Store: 574000431 INVOICE D. E: 12/01 /09 JS PARTS WASHER 20GA 389399' 1.00 89.99 89.99 PARTS WASHER C SANER 5G 3893915 1.00 39.99 39.99 PARTS WASHER CL •NER 5G 3893915 1.0: 39.99 39.99 SUBTOTAL 89.99 TAX 0.00 SUBTOTAL 79.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 89.99 TOTAL 79.98 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000983082010 624200005613010 Purchase Order: SHOP AMOUNT DUE: 164.98 AMOUNT DUE: 79.99 Store: 574000431 INVOICE DATE: 12/03 /09 Store: 574000624 INVOICE DATE: 11/23 /09 JKT ARCTIC 48 BN CT63 6310411 1.00 84.99 84.99 JKT INS SDSTN XLT MS CT 7037383 1.00 79.99 79.99 BIB CRHT INSLTD BR 46X3 6311653 1.00 79.99 79.99 SUBTOTAL 79.99 SUBTOTAL 164.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 79.99 TOTAL 164.98 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801- 779 -7425 Remit To: Bill To: page 5 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TR CTOR DEPT.30- 1200050860 BRAD HENDERSON ®SUPPLYCO PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000345 �-g Payment Due Date: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: SHIP TO :e INVOICE: INVOICE: 431000977361010 431000982821010 Purchase Order: Purchase Order: TRUCK57 TRK57 AMOUNT DUE: 25.26 AMOUNT DUE: 15.49 Store: 574000431 INVOICE DATE: 11/10 /09 Store: 574000431 INVOICE DATE: 12/02 /09 LINK QUICK ZINC 5/1614 3551042 1.00 2.49 2.49 HOOK 3 /8IN CLEVIS SLIP 3585091 1.00 15.49 15.49 LINK LAP 5/1614 3551107 1.00 1.29 1.29 DRAWBAR 1 /214 HOOK 3PT 0268080 1.00 18.49 18.49 SUBTOTAL 15.49 HITCH PIN 3 /8X4IN 3PT 0268658 1.00 2.99 2.99 TAX 0.00 SHIPPING 0.00 SUBTOTAL 25.26 TAX 0.00 TOTAL 15.49 SHIPPING 0.00 TOTAL 25.26 SHIP TO: INVOICE: SHIP TO: INVOICE: 624100005618014 431000980469010 Purchase Order: Purchase Order: PRESHERWASHER LOVEL AMOUNT DUE: 9.37 AMOUNT DUE: 139.98 Store: 574000624 INVOICE DATE: 12/03 /09 Store. 574000431 INVOICE DATE: 11/23 /09 BUSHING 1 /203 /8IN GALV 3149366 1.00 1.79 1.79 BIB INS DCK MD BK BNCES 7036989 1.00 49.99 49.99 WASH ADAPTER 3 /8IN MALE 3987308 1.00 3.79 3.79 BIB LDS SNDSTN 125 B4 C 7321805 1.00 89.99 89.99 WASH ADAPTER 3 /8IN MALE 3987308 1.00 3.79 3.79 SUBTOTAL 139.98 SUBTOTAL 9.37 TAX 0%00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 139.98 TOTAL 9.37 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 1 Remit To: Bill To: page 6 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 'TOR DEPT.30 1200050860 MARK BAUMGART ®SUPPLYCO PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000346 -Payment Due Date: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO INVOICE: SHIP TO: INVOICE: 431000983450010 624200005619012 Purchase Order: FOUNTAIN AMOUNT DUE: 59.99 AMOUNT DUE: 194.97 Store: 574000431 INVOICE DATE: 12/04 /09 Store: 574000624 INVOICE DATE: 11/23 /09 JKT SHRPA DCK 2XLT TBC 7296006 1.00 59.99 59.99 BIB INS DCK XL BR BNCES 7141271 1.00 69.99 69.99 JKT INS HD XL BR BNCES6 7793183 1.00 54.99 54.99 SUBTOTAL 59.99 BIB INS DCK XL BR BNCES 7141271 1.00 69.99 69.99 TAX 0.00 SHIPPING 0.00 SUBTOTAL 194.97 TAX 0.00 TOTAL 59.99 SHIPPING 0.00 TOTAL 194.97 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000967089010 624100004554011 Purchase Order: SHOP AMOUNT DUE: 144.57 AMOUNT DUE: 143.98 Store: 574000431 INVOICE DATE: 12/17 /09 Store: 574000624 INVOICE DATE: 11/25 /09 CHAIN 03 DOUBLE LOOP 3592064 83.00 0.79 144.57 BIB CARHARTT BLK 46)032 6316263 1.00 71.99 71.99 JKT DCK QLTLD 2X BK CT6 7067299 1.00 71.99 71.99 SUBTOTAL 144.57 TAX 0.00 SUBTOTAL 143.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 144.57 TOTAL 143.98 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 -779 -7425 1 Remit To: Bill To: page 7 of TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30 1200050860 DAMIAN DELPH ®SUPPLYC° PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000347 Payment Due Date: 01/12/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO INVOICE: o 431000982704010 431000982325010 Purchase Order: Purchase Order: 2 SHOP AMOUNT DUE: 82.99 AMOUNT DUE: 109.94 Store: 574000431 INVOICE DATE: 12/01 /09 Store: 574000431 INVOICE DATE: 11/30 /09 HOSE 3/8X50 PR WASH RUB 3823863 1.00 82.99 82.99 RATCHET BINDER 1 /4IN 3599537 1.00 47.99 47.99 RATCHET BINDER 1 /4IN 3599537 1.00 47.99 47.99 SUBTOTAL 82.99 ANCHOR FLIP 5000LB 3018272 1.00 3.49 3.49 TAX 0.00 ANCHOR FLIP 5000LB 3018272 1.00 3.49 3.49 SHIPPING 0.00 ANCHOR FLIP 5000LB 3018272 1.00 3.49 3.49 ANCHOR FLIP 500018 3018272 1.00 3.49 3.49 TOTAL 82.99 SUBTOTAL 109.94 TAX 0.00 SHIPPING 0.00 TOTAL 109.94 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 I REMIT TSC BUSINESS 1 :CCOUNT TOR TRA SUPPLY COMPANY T P .O. Box 689020 ;.i i- SUPPL w :1 i s i; t I1 Des Moines, IA 50368 i, :6 i. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (6035 301# I !-•t i.'11 NAME i i' i i'ii1 1 .iI1. ADDRESS :1 r 1 1' .i i CITY STATE ZIP PHONE I.:1 f'600,110.1 I 114 `Y 1,i)9 1' CUSTOMER TO COMPLETE •r....:•{. „'f 1'11; {.F; Dry CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 i! 1 The undersigned certifies' The undersigned party certifies their exemption from 00 f.' S f compliance with the agricultural payment of sales and use tax on tangible personal t,,,„ fit i, ,,c;,., sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of `uLiuiiii i.;ii,•,'-I and agrees with the General food or fiber, horticulture, aquaculture of floriculture for i a'. 0 oo Exemption Statement at right and resale and /or uses the farm machinery, equipment or To t, t a;' .9U the applicable statement of the other agricultural production items purchased free of ;;r 13: .9.E.' respective state printed on the tax, as defined by state law, and as indicated below. i 4: Z.t a t it ':60 reverse side of this form. iI; :ii23 :;S' i;: 73O'i' ,,0 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they ;'U s i STATE: understand they may be liable for pa of all taxes ..h.. r,. t,; (REQUIRED) due on the purchase price for the goods as.allowed by t '.�4 l (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws.. f-; Kr;aaltJ 1 .{:c,, t i PURCHASER IS ENGAGED IN: (REQUIRED) i 1 iii Resale Under penalty of perjury, signee swears the 11,. :A 1.1i> sc. s? i, •.hc, 1.i11 j ,Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation. '1.t_ i c r i b;;rt ie.' l' PA 11 U i si 17, 1 1 Lc If, Agricultural Production of exemption will cause the purchaser to be to r, cor J e, l,c e' LII ill 'l l it' Lot ,'I j ,f i r (,ry r. n' n 1 Dairy Production penalty and /or other provisions as allowed under state' Livestock Production Q' Floriculture /Aquaculture Production law' ❑.Other: c 7n,i,ir ITEMS PURCHASED WILL BE USED FOR (REQUIRED) !j s. Farm Machinery/Repair' Parts •Government Agency (Entity ,d Livestock Injestibles'or Injectibles 0 Exempt Organization (Entity t 31.5 8 :1 8 i 3 t a x V t t t; r .3 r t a i s t/ s NC only DOT and USGovernmentaree>Sempt o 11...,':r 1,” zt :tt4t2ti';t:8tt:2tt:n2atit4t9 51 ".i fertilizer /Agnchemicals e L 1 I cal i30('i 0734 !t:ii 7,'G!aYS iii Resal Tax Per md r r CI onsumed in Produ (KS) j i Ingredient or Component. Parts (KS) i 1. 1 s 4 i, ni f?•15 r ill {I!, 1,_ i r +r 1 4 p Otherail 1 ?-500 i i OPr i= i t .r 6 t (4•=r•,:icti Ut't f 1.• a) NCI :1.1rit.H0Ci= CUSTOMER SIGNATURE: (REQUIRED) MGR: APPROVAL i USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH '..CHECK- VISA M/C DISCOVER TSC CHARGE ACCOUNTNO.: 'CMG. EXCH. ',DATE Cl QUANTITY. ITEM NUMBER. TAX DESCRIPTION _SNIT PRICE Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT D PAYMENTS ONLY TO: TO TRACTOR SUPPLY COMPANY P.O. Box 689020 Tractor SIIPPir LuraPanr S U PP TY C O Des Moines, IA 50368 16160 3t North TSC TEAM MEMBER TO COMPLETE Westf ie1d, 1N 46014 Please include 16 Digit Account Number (317) 867-3505 (6035 301# NAME CARMEL STREET DEPT :1400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) ?33 CITY STATE ZIP PHONE 431 4310001132 2 983082 12/03/2009 12:33rm CUSTOMER TO COMPLETE 6310411 JKT ARCTIC 48 BN CT6 1,00 e 04,99 64,91' CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencie. The undersigned certifies 631165{ BIB CIZHT 1N5LTD BIZ -1 g The undersigned party certifies their exemption from 1 .00 79,99 i•5•. 79 NI compliance with the agricultural payment of sales and use tax on tangible personal Government 1;4encie sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of Subtotal 161.98 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 7.00% Tier: 0, 00 Exemption Statement at right and resale and /or uses the farm or T machinery, equipment the applicable statement of the y f t a l 164,9E1 respective state printed on the other agricultural production items purchased free of TSC Gard t64 d4,98 reverse side of this form. tax, as defined by state law, and as indicated below. Acct 8:$1 E E a: a: t a :15908 Au t hs 003444 Re:f e :0311333799 PRODUCT IS TO BE USED INTHEFOLLOWING The undersigned party further certifies they pU. 8: sheer STATE: understand they may be liable for payment of all taxes Change 00 (REQUIRED) due on the purchase price for the goods as allowed by Cash Bac k (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Buyer acknowledses the receir t of a cu:,:r/; PURCHASER IS ENGAGED IN:(REQUIRED) to d Resale Under penalty of perjury, signee swears the cony of this sales stir itnd the Purc11a.e Government information on this statement is true and correct irp Exempt organization every material manner. A willfully false representation the described Merchandise shall be in Agricultural Production of exemption will cause the purchaser to be subject to accc:rdance• with the Car dholder A9 r•eemen Dairy Production penalty and /or other provisions as allowed under state Livestock Production Floriculture /Aquaculture Production law Other: Signature: ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibies or injectibies Exempt Organization (Entity t E t E a s E t 8 8 E 8 t Y 8 E 8 8 8 8 8 8 8 218 i 8 8 8 3 t E 8 9 F 2 NC: only DOT and US Government are exempt Fertilizer /Agrichemicals EE: 8EY8E88888S28E8tE8E ,8a88E8E8EE8EEt,.. Consumed in Production (KS) Resaie'(Saies Tax Permit 1 1,.'8 within 7 days to A' survey and be entcreii.in a Ingredient or Cornporient.Paris(KS) rwnthiY- 'drawins f or d tunic to•uir. a Other: $2500 shorrins scree, (Awarded as Gift Card) NO,PUI'CHASE vt I s ER SIGNATURE (RE RED) MGR. APPROVAL A' 1/e/ USE SHADED AREA ONLYWHEN REGISTER IS INOPERATWE. CASH CHECK 'VISA WC 'DISCOVER 'TSC CHARGE'ACCOUNT NO a' i CHG. EXCH,; DATE QUANTITY r ITEM NUMBER NON DESCRIPTION UNIT PRICE TAX= Form No. 99-00401 (12/08) CUSTOMER ORIGINAL' FlIGIVIIII II I .4.0 saHLJIQIIIVIG..7.71 F-1‘.•%-olau iv u e PAYMENTS ONLY TO: T TRACTM TRACTOR SUPPLY COMPANY P.O. Box 689020 i SUPPLYC,.. Des Moines, IA 50368 i: TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (6035 301# NAME r :1;' 1 06 1 i ADDRESS H1 CITY STATE ZIP PHONE •i.s• i ,:ti 0(3;i6. 1 'i.i.:'(1r:=: 01 CUSTOMER TO COMPLETE W6:.'.)6 ii:3 f.',: t r10 :2../ ;t, CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from ;.,1„..' payment compliance with the agricultural of sales and use tax on tangible personal sales tax exemption law of the state 0 .00 property as indicated below and/or purchaser is i,:i, indicated below and understands engaged in the business of agricultural production of ISi. ii:a: 0' and agrees with the General food or fiber, horticulture, aquaculture of floriculture for '1 ILITt16096 Exemption Statement at right and resale and/or uses the farm machinery, equipment or f :004 WO Ref D:.',i.1•:',;./,' the applicable statement of the other agricultural production items purchased free of. I'D :1,„ t z. respective state printed on the tax, as defined by state law, and as indicated below. reverse side of this form. PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they understand they may be liable for payment of all taxes STATE: t•I ot i ;',.1 1:. (REOUMED) due on the purchase price for the goods as allowed by Li (Exceptions: Georgia, New York 8 Kentucky state law should such goods be used or consumed in 01.. !i:-; 1 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 1 PURCHASER IS ENGAGED IN: (REQUIRED) il:':'' d'' i':.:t r_ hisH:. ••.:ii. i I i. o Resale Under penalty of .perjury, signee swears the 1!-. C. i'. 0 Government. information on this statement is true and correct .in O Exempt organization every material manner. A willfully false representation O Agricultural Production of exemption will cause the purchaser to be subject to 0 Dairy Production penalty and/or other provisions as allowed under state 0 Livestock Production law. 0 Floriculture/Aquaculture Production O Other: ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) tlilriA3if '1(.1:!:•Th:.:1 •..".1 O Farm Machinery/Repair Parts 0 Government Agenci (Entity 12Y 3 tt- I•lii.1..1.7 1 1 X'tit'3 (I CAI 200 ',',::2 07V1 ‘t. it 7 C.s. i 0 Livestock InjeStibles or Injectibles 0 Exempt Organization (Entity •■.r .1.i- I 1.-,s-- t.-,, I NC: only DOT and US Government are exempt 0 Fertilizer/Agrichemicals Lir vtli tit Cott 0 Resale (Sales Tax Permit 0 Consumed in Production (KS) s ii.ir;-- ri'!.3 5t.vc 1•1A;.;1:. 0 Ingredient or Component Parts (KS) 1 A'')' N; '1.. Eri O dIher: I Ft 1 ij:e2 t. i 4 4 '4, ,f..;•4: 4 t 4_4 t 4 CUSTOMER ':•"pt4;••■•;GNMED) MGR APPROVAL e X. g USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH. .CHECK :-.VISA M/C DISCOVER TSC CHARGE ACCOUNTNO. :'2 i CHG.: EXCH. DATE I...1 NON QUANTITY 'ITEM NUMBER DESCRIPTION I SNIT PRICE TAX Form No. 99-00401 (12/08) CUSTOMER ORIGINAL l�/ ffos:: c CI Y�� N0� 0�P TractorSupplycom 2375 [AST PLEASANT ST., RT. 37 2375 EAST PLEASANT ST., RT. 37 NOBELSVILLE, IN 46060 NOBELSVILLE, IN 46060 317 U 317 4554 Ticket: Ticket: 5613 Date: 11/26/09 Time: 2:16 PM D Time: 18:02 AM Store: 621 Register: 1 Store: 621 Resister: 2 Cashier: 00333996 �om6ir,' OA3J3996 Business Customer: CHRMEL STREET DEPT Business Customer: CHRMEL STREET DEFT 3100 W 1313T ST J�OO W 131ST ST W53TFIELD. IN 46074-8267 Woatf|o]d. IN 46074-8267 317-733-2001 317-733'2001 Amount BIB CARHARTT BLK 46.X32 JKT INS SDSTN XLT M% CT63 6316263 1 71 .99 71,99 E 7037583 1 79.99 79.99 E JkT DCK OLTLU 2X 8K CT63 7067299 1 71.99 71.99 E Subtotal 79.99 Tax 0.00 Subtotal 143.98 Total Ty�99 Fax 0.00 rSC Business Account 79.99 Total 143.98 XXXKXxXXXXXX5916 Ruth 4:023387 TSC Business Account 193.98 PO 4: XXxKKXxKxxxK6153 Buyer: RANDY JOHNSON Outh 4`025689 p0 4: Buyer: DAMIAN OELPH Change 0,00 A aoree to poy the above amount according to my card issuer uyreem«nt. Cho»yu 0.00 wree to Pay the above amount according to my card issuer agreement. «**x*o°omoxw*w°**********^****»****°*o**u Tax Exempt Information v*o*ow**o*w*o*w°o*xo**°°xooxo**y**o*°xo°m*xw Name: CnRMEL STREET DEPT Tax Exempt Information oddre,o: 3400 W 13lST ST City/St: Westfield, IN Name: CHHM[L STREET DEPT Zip Code; 16071-8267 Address: 3400 W 131JT ST Phone: 317 City/St: WE3TFIE0. IN Zip Code: 4607+8267 Tax Exempt. Reason: Government Agencies Phone: 317-733-2001 Expiration Date: Tax Exempt Holder: Tax Exempt Reason: Government Agencies Expiration Date: Under penalty of perjury, signee swears the Tax Exempt Holder; items he/she has Purchased the applicable o a aD a a 1L a •T DEC 0 7 200 tl a L n a n Tsr TRACTOR ..4L SULYC® TractorSupply.com 2375 EAST PLEASANT ST. RT. 37 NOBELSVILLE, IN 46060 317 776 -1883 TRACTOR T i cl:.e i 9080 SUPPLY C9 Date: 12/10/09 Time 10:45 AM i TractorSupply.com Store: 624 Re9r•ter: 2 Cashier: 00125109 Customer Name: XXX CRRMEL .TREET DEPT 2375 EAST PLEASANT ST., RT. 37 Phone It: 3177332001 NOBELSVILLE, IN 46060 317 -776 -1883 SPECIAL OR'i ER PO Ticket: 5619 80000'45 toate: 11/23/09 Time: 10:10 AM (Store: 624 Resister: 2 Vendor: TH, BERNE PPAREL CO (Cashier: 00333996 Vendor Id: 515106 Business Customer: CARMEL STREET DEPT Vendor Item_it_Qt. Price Amount_ 3400 W 131ST ST sweat shirt 1 Westfield, IN 46074-•8267 222220 Special Oroe Article 317-733-2001 52101 4 24.00 96.00 E Clothing Item Qty Price Amount Pick Up .BIB INS DCK XL BR BNCES65 sweat shirt xl 7141271 1 69.99 69.99 E 222220 Special Or.e Article JKT INS HD XL BR BNCES63 S2101 30 24.00 720.00 E 7793183 1 54.99 59.99 E Clothing Pick. Up BIB INS DCK XL BR BNCES65 sweat shirt 7141271 1 69.99 69.99 E 222220 Special Order tic:le 52101 '.0 24.00 480.00 E Clothi 9 Pick hp Subtotal 194.97 Tax 0.00 sweat shirt x t Total 194.97 222220 Special Order Artic e SZ101 8 24.11 192.00 E Clotting TSC Business Account 194.97 Pick UP XXXXXXXXXXXX6104 Auth 4:023768 sweat shirt 'xli PO A: 222220 Special Order Article Buyer: TERRY KILLEN S2101 2 24.00 48.00 E Clot ins Change 0.00 Pick UP I agree to pay the above amount according to my card issuer agreement. sweat shirt 3x1 222220 Special Order Article SZ101 8 24.00 192.00 E Clothing K** Pick UP Tax Exempt Information Name: CARMEL STREET DEPT REMIT TSC BUSINESS ACCOUNT TRACT R® PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY S UPPI _..YCO P.O. Box 689020 Tractor SUFP1Y Company Des Moines, IA 50368 18160 U.S, 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West +field, IN 46074 (6035 301# (317) 867 3505 NAME CARME-L STREET DEPT 3.400 W 131ST ST ADDRESS WESTFIELD Its 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000120 2 9G7089 12i17/2009 09 :20am CUSTOMER TO COMPLETE 3592064 CHAIN 03 DOUBLE LOOP 183.00 0.79 144.5 Ni CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the ag payment of sales and use tax on tangible personal oubtot -d. 144.57 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00 Tax O. indicated below, and understands Total 144.57 engaged in the business of agricultural production of and agrees with the General TSC Card 144.57 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct: ii$taisiis :17 the applicable statement of the other agricultural production •items purchased free of Attth$:017610 Ref:1748204763 respective state printed on the tax, as defined by state law, and as indicated below. PO ha r i shoal reverse side of this form. y Cnse 0.00 Th undersigned party further certifies they Cash Back PRODUCT IS TO S�ED�N THE FOLLOWING 9 p Y STATE: fV understand they may be liable for payment of all taxes Bt,Yer acknowledses the receipt of a 77kle EQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed In COMPLETE REVERSE SIDE) COPY of this sales slip a the P U1't i t a:! a a taxable manner as defined by state laws. f PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the the described merchandise shall be in overnment information on this statement is true and correct in accordance with the Cardholder Asreelaeuc O Exempt organization every material manner. A willfully, false representation EL Agncunural Production of exemption will cause the purchaser to,be sub to O DairyProductioh S.LsnatUrE: penalty and/or other provisions as, un state 0 Livestock Production i 0 Floriculture /Aquaculture Production law' t Other r z I t ITEMS PURCHASED WILL BE USED'FOR: (REQU(RED) t. p5.) .i Ill 7 V 1 ii$Y$ $YStE$EiiBiii$Y i$i$i$4Y i8ii;YY1$ FarmMachmery/Repair Parts O GovemmentAgehcy(Entity I_ t %)I ;l ii iii i2282t 2iiiltii888tii8ii.iiiii$8 "3 1 f 0 Live In)estibl or in)ect +)-0 Exempt Or :(Entit s t i i 1' -t 1 r) Ipi Call 800-968 °0754 Within e eri to Fertj e r /A i •NC only DOT end• USGovernmenta4ee empt4, 1 x y r i! i j co a 'Stir and be enterer! in t;' m di•awins f or a Chanel to uin 1 1* T 31•' .r i Re (Sales Tax Perm ,f,�,r 'A,j 1 c i O �Consuml d in Pr (KS) a kit S h OPP i ns 5r rPP'. H 1 I I 't i(h� If r war ar ea. 5 G ir d) if0 t'URCHA' Ing}ed(ent or Com Parts (KS r•}` t, elt r y •l ',f (AS I f t' Car C t t 4 Other 1 t i ,1 r s r 4+ T t a l i l OR t fcV tdEl �:,,,ARY rid r_ i 0' f t: I i r I $$?iEt$$$ 3“.titittr i $3d°:hii4 j ar s 1 r t r ik tr l 7 �i j i,. 3 3 !�r l f. z -t a i n s 4,;11,;,,, t p., CUSTOMER SIGNATURE: (REQUIRED 110 )1 1 'MGR. APPROVAL I w y{ c. r- 1. USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE 7 Form No. 99-00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY 70: 0 TRACTOR SUPPLY COMPANY SU LY'CE2 i P.O. Box 689020 Tfelo.Aur SUPh C,h1PAVlr Des Moines, IA 50368 1 U.S. 31 N ,r tb TSC TEAM MEMBER TO COMPLETE f field, IN 460<<t Please include 16 Digit Account N umber (317) 867 350'3 (6035 301# NAME (;Ak11El_ MEET ULF T 5400 W 131ST Si ADDRESS VISTFIELD IN 46074E:3267 (31 I') 733-2001 CITY STATE ZIP PHONE 431 4310001.1:' 2 986201; 12 ✓14/2009 10: •-Ini CUSTOMER TO COMPLETE 712103 s,jr5t11^ %1._ 41001..i 1,00 L 2.99 25.99 OT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Rt:3. Price: 29.99 The undersigned certifies The undersigned party certifies their exemption from Gov!TSnient n:Venca.f,3 compliance with the agricultural g p Y p 712101 Y'JTSI XL loon tly� sales tax exemption law of the state payment of sales and use tax on tangible personal 1 .00 e 23,9% 2:.99 NI indicated below and understands property as indicated below and/or purchaser is Price: 25'39 and agrees with the General engaged in the business of agricultural production of G6vern„V tlaencies Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for the applicable statement of the resale and/or uses the farm machinery, equipment or subtotal ;1.98 pective state printed on the other agricultural production items purchased free of 7,00% Tau 0,00 res reverse ve e t this form. tax, as defined by state law, and as indicated below. Total 47,9P, Th undersigned party further certifies they 15C t:ard 47• PRODUCT IS TO BE USED IN THE FOLLOWING g P Y Y nccto;EEE3ESa>zusEt:ii'95 STATE: understand they may be liable for payment of all taxes ,tfra' :01 1 Re 140947142f, (REQUIRED) due on the purchase price for the goods as allowed by I,C1 tt 235' (Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in Chen se 0,00 COMPLETE REVERSE SIDE) a taxable manner as defined b state laws. Y. Casa Back PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Buyer acknolleds.s the receipt of E cartrl•i Government information on this statement is true and correct in. Exempt organization every material manner. A willfully false representation. curr of this }ales slir ane 'the. t „ri.:,.,� Agricultural Production of exemption will cause the purchaser to be subject to: Dairy Production andlor other provisions as.allowed under state:. [7] Livestock Production penalty. p the described merchandise shall b>? in Floriculture /Aquaculture Production law accordance with- l E P k :Lim Other: ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) b ].snature: Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit 1' E 3 t E E E g Y; t i ,g E 3 E E :t E i 3 3 E t E 3 E 8 t Y 3 3 S 3 2 Y 8 E3t88EfE:E 33*31 3.?A,#Eh¢E E&$3EE38uE1: °8a .Ingredient or Component Parts (KS) call: teO 9611-0734 141 t i 7 d, s 10 Other °,.cantr1 ,e- a st.t rver. 4rti3 tae etitet ed a u a' V rinnth,l d e1winh 3.11 a• [At win- rt: CUSTOMER SIGNATURE:(REQUIRED) MGR. APPROVAL X. USE SHADED AREA ONLY WHEN :REGISTER IS INOPERATIVE. CASH CHECK' ,VISA. M/C DI TSC` CHARGE ACCOUNT NO •••CHG EXCH.. DATE f x 0. .0 4. QUANTITY ITEM NUMBER NON DESCRIPTION @NIT PRICE Form No. 99=00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT �1RAC�R® TRACTOR SUPPLY COMPANY S UPPI.1YCO P.O. Box 689020 Tractor Supply Company' Des Moines, IA50368 18160 U.S. 31 Forth TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number W <`stf 7eld. Ird 46074 9 (317) 86r -3505 (6035 301# NAME CARMEL STREET DEPT 3400 W 131ST ST WESTFIELD IN 46074826? ADDRESS (317) 733•••2001 CITY STATE ZIP PHONE 431 431000172 2 982325 11/30/2009 10:14am CUSTOMER TO COMPLETE 3599537 RATCHET BINDER 1/41N 1.00 47.99 47.99 MT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Agencies The undersigned certifies 3`399537 RATCHET BINDER 1 /4IN g The undersigned party certifies their exemption from 1 .00 47.99 47.99 .4I compliance with the agricultural payment of sales and use tax on tangible personal Government Agencies sales tax exemption law of the state property as indicated below and /or purchaser is 3018272 ANCHOR FLIP 5000LB indicated below and understands engaged in the business of agricultural production of 1,00 3.49 3.49 f' and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and q Government Agencies the applicable statement of -the resale and /or uses the farm machinery, equipment or 3018272 ANCHOR FLIP 5000LB pective btate printed on the other agricultural production items purchased free of 1.00 3,49 3 49 NI the reverse side t this form. tax, as defined by state law, and as indicated below. Government Agencies 1118272 ANCHOR FLIP 5000LB PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 1.00 3.49 3 49 NT STATE: uhderstand they may be liable for payment of all taxes Government Agencies .4 (REQUIRED) due on the purchase price for the goods as allowed by 3018272 ANCHOR FLIP 5000LB (Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in 1.00 3.49 3.49 NT COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Government Asenr PURCHASER IS ENGAGED IN:(REQUIRED) Resale Under penalty of perjury, signee swears the Subtotal 109.94 Government information on this statement is true and correct in 7.00% Tax 4,0V Exempt organization every material manner. A willfully false representation Total 109.9 Agricultural Production of exemption will cause the purchaser to be subject to TSC Card 109,74 Dairy Production penalty and /or other provisions as allowed under state A cct :111 s 3 t 121 s 116161 Livestock Production law. Auth #:030585 Ref #:3009140101 Floriculture /Aquaculture Production Other. Ciianse 0.0n ITEMS PURCHASED WILL BE USED FOR :(REQUIRED) Cash Back Farm Machinery/Repair Parts Government Agency (Entity Buyer tuknowledses the receipt of a comv1t Livestock Injestibles or lnjectibles Exempt Organization (Entity to d Fertilizer /Agrichemicals NC: only DOT and US Government are exempt COPY of this Sales slip and tht` ru.'t lr• r, Consumed in Production (KS) Resale (Sales Tax Permit f the dserbed merchandise shall be in IngredientorComponentParts(KS) accordance with'; the Cardholder "Aarec,4-Ut,• Other. Sisnature CUSTOMER SIGNAT (REOUI .MGR. AP USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. TSC CHARGE ACCOUNT NO. :CHG.. EXCH. DATE: CASH CHECK VISA MIC DISCOVER r QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE Form No. 99-00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT W TRACTOR PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY SU PPLYC° P.O. Box 689020 Triictor S. r'lY Coopan'a Des Moines, IA 50368 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE g WL stf field I 1 46074 Please include 16 Digit Account Number (31 7) 136 3505 (6035 301 NAME CARPEL.- a1REE F DEN 31100 14 131ST ST ADDRESS WEST FIELD IN 460743267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000172 2 9810740 11/24/2009 10:04am CUSTOMER TO COMPLETE 1833553 LOCKPIN SW 1/ X 2 1 1,00 2 2.49 2 49 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from 1833553 LOCKPIN SW 1/4 X 2 1 compliance with the agricultural payment of sales and use tax on tangible personal 1.00 L 2.49 2,49. NT sales tax exemption law of the sta te property as indicated below and /or purchaser is Government F? s_nc firs indicated below and understands 1833553 LOCI: IN SW 1/4 X 2 1 and agrees with the General engaged in the business of agricultural production of i.00 D 2 2.49 2.49 NT Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Government Agencies t of the resale and /or uses the farm machinery, equipment or 1113'3553 LOCKPIN S(1 1/4 X 2 1 the applicable statemen the sta tem on the other agricultural production items purchased free of 1.00 2 2. 49 2.49 NT reverse side of this form. tax, as defined by state law, and as indicated below. Government Asencie:; 1933553 LOCKI II' SW 1 /4 X '1 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 1.06 e 2.49 2.49 N STATE: understand they may be liable for payment of all taxes Governn)ent Ase;xcies (REBUIRFO) due on the purchase price for the goods as allowed by 1833533 LOCKPIN SW 1/4 X 2 i (Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in 1.00 8 2.49 2 49 `T COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Government As*ncies PURCHASER IS ENGAGED IN: (REQUIRED) 0268666 HITCH PfN 1 /2X413 3P Resale Under penalty of perjury, signee swears the 1 00 e 3,99 3.99 NT Government information on this statement is true and correct in Government Asencies Exempt organization every material manner. A willfully false representation 02613666 1-1ITCH PIN 1 /2X 4IN 3P Agricultural Production of exemption will cause the•purchaser to be subject to 1.00 t 3,99 3 y2 NT Dairy Production penalty and /or other provisions as allowed under state 6bverv)yn t Asencia_ Livestock Production FloriculiurelAquaculture Production law 02606,1i.- HITI: H Prii 1/'2X4111 3F' Other: 1,00 2 3,99. 3,99 NT GovernAent Asencses ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) 026F.t66 H I t (l1 1 IP1 1 4iN F' Farm Machinery/Repair Parts Government Agency (Entity 1 D''�'' l 6, 9: NT Government Aa nty.c Livestock Injestibles or Injectibles Exempt Organization (Entity t89113I F_$R PIN CLIP 5/1311 8 NC: only DOT and US Government are exempt' Fertilizer /Agrichemicals 1.00 2 .97 4. N Consumed in Production (KS) Resale (Sales Tax Permit 1 Government Asen.C ,1891137. i=t PIF4Ct.IP 5/3113 B Ingredient or Component Parts (KS) 1 (1(3 "'C -4; vv i. .4 ;'9 t■ i Other 0I.NIfl• illtIt 11 seiDCies F1NS:CLLF •5 /)3lid. B. 1 1:8911Z.';'1,.-4-8,R 1 8 "4'.99 4.95 ;�)T ST. ME S NATURE:(REOUIRED); MGR APPROVA is GOve ,ASeneles 02 X j fj USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. 1 A` CHECK VISA rv■/C DISCOVER TSC CHARGE ACCOUNT NO 4 ,CMG EXCFi: DATE r QUANTITY ITEM NUMBER NAx DESCRIPTION SNIT PRICE Form No. as- 00401(12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T 0 TRACT PAYMENTS ONLY TO: SC TRACTOR SUPPLY COMPANY SU Box 689020 3568887 G8 GALV AND COTTLRPI Des Moines, IA 50368 10,60 E 3,49 36,99 Nf TSC TEAM MEMBER TO COMPLETE Government Asencies Please include 16 Digit Account Number (6035 301# Subtotal 82 35 NAME 7.00% Tax 0,00 Total 82,86 ADDRESS TSC Card 82,36 Accte:itttititttti4803 Auth0:024960 Reft:2409040484 CITY STATE ZIP PHONE PO *:Shop Chanse 0.00 Cash Back CUSTOMER TO COMPLETE Buyer acknow.l the receipt of a rumple CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: to d The undersigned certifies COPY of this sales slip and the purchase o g The undersigned party certifies their exemption fror>� compliance with the ag payment of sales and use tax on tangible personal the described merchandise '_i,a11 be in sales tax exemption law of the state property as indicated below and /or purchaser is accordance with the Cardholder Asreerie nt indicated below and understands engaged in the business of agricultural production of and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or y Sisna tore the applicable statement of the other agricultural production items purchased free of respective state printed on the reverse side of this form. tax, as defined by state law, and as indicated below. PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes tits: tttttitttttittst ::tttttt:24t.tsmi ∎k (REQUIRED) due on the purchase price for the goods as allowed by tttittitttttttttstt ittttti"sitstm stS Exceptions: Georgia, New York &Kentucky state law should such goods be used or consumed in Call 000 -968 -0734 within 7 ddy to COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. complete a survey aoth be e» it red in a PURCHASER IS ENGAGEDIN:(REQUIRED) monthly drawins for a chance to tin Resale Under penalty of perjury, signee swears the $2500 shoepins spree. Government information on this statement is true and correct in (Awarded as Gift Card) P'0 PURCW.SE Exempt organization every material manner. A willfully false representation UR SURVEY NECESSARY. Endo 9.'30/10 Agricultural Production of exemption will cause the purchaser to be subject to :.z a e :..,:z 3 3 a ii 3 L 3 n .1, r a 3 Dairy Production penalty and /or other provisions as allowed'under state. Livestock Production P. law Et t ore a 01,': D Floriculture /Aquaoulture Production Other``, k t r f For c Jetai3 ITEMS PURCHASED WILL BE USED FOR (REQUIRED) t i '1' Ti dct07 1 PF1 /,cr CLIP i;r tfi`vi•Y Farm ■achinery /Regair Parts Government Agency (Entity 1 i 1; i+ 1 c e i 3 3 3 8 3 3 '3 a X d i -3 a II d.. 8 L 2 2 t ;t t ';i4:; a o. T e$Z$ EE ZZ8St ?,SA 334$£d33II Livestock Inlestibles' or In)ectibles Exempt Organization (Entity 1 i f i r l I' y lr II; ro Ct,:<u n r Service c1 .Ineu is NC o nl y DO and US Government are exempts* f I C 1 1, �i7 8 i ?771 t1 t 0 Q Fertilizer /Agnchemicals r t j, 1 p f "t o Co «,n ine r Resa T a x P er mit t) u rat 1 Ut '�L1P 1= 1'>' CU) I. ns in Production (KS) r i' 3 ngredi 11,'1)1 F 1 )f Tr k 4 x4 k UI '1. Aed. c:1 0,. or Ct.1stomer t: ir.'o e Id)' ent or Component Parts (KS) `t x 1 +=y .I Y t t t r t i 3 L 3 8 2 -II 38 4 C 3 d ,t- w; a r .t /S IC '+ia 6. r+r s Ot hefi i �G It s 1 3SRio S t8LII8 8;ii ?1L $8 >bB i, 1 `t Call.1tCw 'a!:OP Di1111': at i US 0 ER SIGNATURE: (REQUIRED) MGR. APPROVAL A 4 4gD 7 x r" f' O USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. JCAS' CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE e Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TO: SUPPLY TIER TRACTOR PPLY COMPANY SUPPLY C® P.O. Box 689020 Tr actor SueFly Comp Ezny Des Moines, IA 50368 i 6U u s 31 PJor th TSC TEAM MEMBER TO COMPLETE W�•�tf field, ttt 460•r•4 Please include 16 Digit Account Number (317) 867--3505 (6035 301# NAME CHRt1EL STET DEPT 3400 W 131Sf ST ADDRESS WESTFIELD IP 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000187 2 982704 12/01/2009 03:46Fm CUSTOMER TO COMPLETE 3823863 HOSE 3 /CX50 Pk WASH 1.00 e 82,97 82,79 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from Subto t 11 8?, 99 compliance with the agricultural payment of sales and use tax on tangible personal To to Tax 0.00 sales tax exemption law of the state property as indicated below and /or purchaser is T tai 82,9; indicated below and understands agrees with the General engaged in the business of agricultural production of .rsc Car 112.99 and agr food or fiber, horticulture, aquaculture of floriculture for Acct ERXt$8$$t$$t6153 Exemption with Statement the right and the applicable resale and /or uses the farm machinery, equipment or Authit:001107 Ref>k :0114455442_ respective state la statem tement of and printed on the other agricultural production items purchased free of PO :0 reverse side of this form. tax, as defined by state law, and as indicated below. C;,a;;,e 0,00 Ca h Bric k PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes Buyer acknowledses the receiFt of a rk1e (REQUIRED) due on the purchase price for the goods as allowed by. (Exceptions: Georgia, New York &Kentucky state law should such goods be used or consumed in copy of This sales 'iliP and ills Nuvcha e o COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. f PURCHASER IS ENGAGEDIN:(REQUIRED) the described merchandise shall be in 0 Resale Under penalty of perjury, signee swears the accordance with the Cardholder ;SSrecient, Government information on this statement is true and correct in 0 Exempt organization every material manner. A willfully, false representation 0 Agricultural Production of exemption will cause the purchaser to be, subject to Si, D Production penalty.and /or other provisions as'allowed under state Livestock Production l O; Floriculture /Aquaculture Production law' q t -0 Other, 1 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) '..t} i l I( ti,( E 8 8 8 t t t t t s t t 8 t E 8 E 8 3 8 F arm'Machinery /Repair •Parts •Gov Ag (Entity it I I r i 3 Y 8 tt 9' 2t t Y t t Y t.w 8 t: 8 r Call 800 9600734. within i. r1;}:s to 0 Livestock I n)estibles or In)ectibles 0 E xem t Or anization E ntit r3 .11 j P 9 y x I rl„ omP le'te a survey and be er,yere+; 1R 1 NC only DOT and US Government are exempt a h #i' Fertilizer /Agnchemicals 1: ft E1. a7" t "IIt Y dr�win for 8 chance i !sr y, "a, .'._t r i r s t, F vt r'. $27' 5Prec y.. 3 ,Q 'Resale •(Sales T a x Pe 7 4 r�i) t I 00 ShoPri11S C o n timed in P (KS) I a}iI rI r 1 (Awa tS Gi ft. C NO r. r Co C#iASC 1 Ingredient omponent Parts (KS x i 61= t t 4 z F E c 4 t 1�r, aUkVc AlFCESSfi�Y )t• 730/ 0 S 17 f' 1 1 l 3385' 818 ti8A38ttt •8tattt2t.:Et4 i i ,ti, a t i 4 4 a, 1 i I i I t :)I 1 S,t lirlS -,I. t 3 E 4 r _firer "e.. rsu "x• t i H.. CUSTOMER SIGNATURE: (REQUIRED) M APPROVAL .&e- r% USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE O NON QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE 3 Form No. 99 -00401 (12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TRACTOR PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY SUPPLYC2 P.O. Box 689020 Tractor StIPPlr Coul,�aa Des Moines, IA 50368 1C14:10 U.S, 31 North TSC TEAM MEMBER TO COMPLETE 1Je.� t f ie ],d, IN 460' Please include 16 Digit Account Number 317) 867 3505 (6035 301 NAME CARfMEL STREET DEPT 3400 W 131ST ST ADDRESS (<IESTFIELD IN 460 (31 1) 733 -2001 CITY STATE ZIP PHONE 431 431000172 2 982t321 12/02/2009 10:29iaiii CUSTOMER TO COMPLETE 3585091 HO3K ';rdIN CI<cviS St. -1.00 15.49 15.49 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: i;over Iliren't A !T c ies The undersigned certifies The undersigned party certifies their exemption from Subtotal 15.99 compliance with the agricultural payment of sales and use tax on tangible personal 7.00% T: .ix 0.00 sales tax exemption law of the state property as indicated below and /or purchaser is 1°1E11 15.49 indicated below and understands engaged in the business of agricultural production of 1SC Card 15.49 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for c tt: tea (5 -);t ttt #x5973 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Aut11 :002303 lief :0209290766 the applicable statement of the other agricultural production items purchased free of PO tt:: trk 57 respective state •printed on the tax, as defined by state law, and as indicated below. C; 0.00 reverse side of this form. Cash Back PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes By er ac knowled i the recei r t o F a 1#,e (REQUIRED) due on the purchase price for the goods as allowed byt ad Exceptions: Georgia, Now York& Kentucky- state law,should such goods be used or consumed in COPY o'f this sales 31ie and tt,; rurchaae o COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. f PURCHASER 'IS ENGAGED IN: (REQUIRED) the de_•:.ribaci merchandise shall be :i.il ❑'Resale Under penalty of perjury, signee :swears the acccndance with the Cardholder A,r:�et:lent, D Government information on this statement is true and correct in ExempLor'ganiz every material manner. A willfully false'representation Agrk i1tural Production of exemption will cause the purchaser to,be s to 5isnat, ere: p Dairy Production penalty.and /or:ot provisions as allowed 'understate: E Livestock Pro Q Floriculture /Aqu Production law. l Other t z 1 6. t ITEI415PURCHA (REQUIRED] .j i 8 u2* 2 $2 82 d@$t$$ #;19.4 t 0 iqi ine j z e r #t8 #1 ##Yt6tt:t' 8*IS EL&88r8'r i )t$2gb28 Farm Mac Repair Parts G o vernment Agency (Entity E a i 1 1 1' x L ivesto c k Ir es tibles or Irr ed ibles 0 Exem t Or tion: "(Entity '41'i.:,--1 fl I lrak 800'-?68-07:4 n o t1l i r1 e e d to I. a r z i.. t. r �w r r H. i❑ r 1 1 ti 0 p .9 ty s iiio.1i c.avip'1ete ar 1:..1:4'ey an be, rife; e ]11 a 11 f NC only DOT and US Government •are exempt s l >t 'till Fertllrze0Agnchemrcals` i i I .0 r 5 1 rtl r a l I i e r p g i fl iIY, G Ti' ,F(7 -n7 'l or a ch to rJkii tj. o i r as ns stki od k. 0 R e s a le Tax Permit l,i z rY I i:�1 1 t J: t Z Y '0t) sti tee i 5 'rie rji C oumed ir P r o duction K S .1 yy r n�'� -f�1:1 i- i., r3 .c ta} v t S l rt' f t IWt3 3 f f a `.��,11f13A �p ingredient or :Component Parts (KS) t u i §i t b �u I s l l 91 T1 SU{c F r 9' t Cf t E lide r. 300 1 t r x' Oi her il e 4 r I f t 1 i.ttl4 f a!d( li *f /ET8'�itt:4$ a+3t.6t#ts -$7i tilT48*f3.. szl: k i i s 1 i is 11 i14 /li i 4 i 3, r r.l s tl 5 14 Y� v P 'i t- t_i.r. y.. x 3.Y ,s.. r t :ch r l CUSTOMER SIGNATURE :(REQUIRED} 'MGR. APPROVAL 4.-L,, 2 2 •x USE SHADED AREA ONLY WHEN:REGISTER.IS INOPERATP/E. CASH CHECK' VISA s' M /C. DISCOVER TSC CHARGE ACCOUNT NO y- CHG. EXCH._, DATE QUANTITY ITEM NUMBER NON DESCRIPTION v NIT PRICE' TAX Form No. 99 -00401 (12/08) CdSTOMER ORIGINAL TRACTOR SUPPLY C9, TractorSupply.com 2375 EAST PLEASANT ST., RT. 37 NOBELSVILLE, IN 46060 317 -776 -1883 ticket: 5618 Date: 12/3/09 Time: 2:15 PM Store: 624 Register: 1 Cashier: 00327137 Business Customer: CARMEL STREET DEPT 3100 W 131ST ST WESTFIELD, IN 46074 -8267 317- 733 --2001 Hop, 1)1; Price Amount .`,HIPJG 1/2X3/8 1N GHLV 3149366 1 1.79 1.79 E WASH ADAPTER 3 /8IN MALE NPT 3987308 1 3.79 3.79 E WASH ADAPTER 3 /8IN MALE NPT 3987308 1 3.79 3.79 E Subtotal 9.37 Tax 0.00 Total 9.37 TSC BuLiness,Accnur,t 9.37 XXXXXXXXXXXX6070 Auth 4:6035301200050860 PO tt pressure sher Buyer:. WILLIAM DAVIS Change 0.00 I agree to Pay the above amount acc.rding to m� card issuer agreement. if MM) f# M**N il#M ifnxlEi(M iflfklf kif #itMMik *****tt# #iEiFffi Tax Exempt Information Name: CARMEL STREET DEPT Address: 3400 W 131ST ST Cit4 /St: WESTFIELD, IN Zip Code: 46074 -8267 Phone: 317 733 -2001 Tax Exempt Reason: Government Agee lh.:Pirat ion Date: VTRACTOR SUPPLYC9 TractorSupply.com 2375 EAST PLEASANT ST., RT, 37 NOBELSVILLE, IN 46060 317 776 -1883 Ticket: 9080 Date: 12/10/09 Time: 10:43 AM Store: 624 Register: 2 Cashier: 00125109 Customer: XXX CARMEL STREET DEPT Phone t: 3177332001 Cumpany: CARMEL STREET DEPT Item 0ty Price Amount sweat shirt 1 Special Order Article 222220 1 21.00 96.00 E SZ101 Clothing Special Order ID S106242100046 sweat shirt xl Special Order Ariicle 222220 30 29.00 720.00 E 52101 Clothing a Special Order ID S106242100046 sweat shirt Special Order Article 222220 20 29,00 980.00 E 52101 Clothing Special Order ID S106212100046 sweat shirt xlt Special Order Article 222220 8 29.00 192.00 E P S2101 Clothing Special Order ID S106212100046 sweat shirt 2x1t a Special Order Article 222220 2 29.00 18.00 E SZ101 Clothing Special Order ID 5106292100046 sweat shirt'3x1 Special Order Article 222220 8 29.00 192,00 E SZ101 Clothing Special Order ID S106242100046 sweat shirt li Special Order Article 222220 2 24.00 18.00 E Sz101 Clothing Special Order ID 5106292100096 Subtotal 1776.00 Tax 0.00 Total 1776.00 TSC Business Account 1776.00 XXXXXXXXXXXX9795 Ruth 11:010082 PO 1: VOUCHER NO. WARRANT NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $3,053.09 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Depa ment PO# Dept. INVOICE NO. ACCT /T LE AMOUNT Board Members 2201 42 370.00 $445.22 I hereby certify that the attached invoice(s), or 2201 43 560.01 $2,607.87 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except i „Uanua 2010 UCW/ I i A41417 Street Commissioner tY Vll Gl.1 V i 111 IIJJIUI l it Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/30/09 $445.22 12/30/09 $2,607.87 I hereby certify that the attached invoice(s), or bill(s), is (are) trueand correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer