182113 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
2,
ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $679.83
CARMEL, INDIANA 46032 PO BOX 689020
a, DES MOINES IA 50368 -9020 CHECK NUMBER: 182113
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 603530120005 91.60 6035301200050860
2201 4237000 603530120005 99.60 6035301200050860
2201 4238900 603530120005 298.65 6035301200050860
2201 4356003 603530120005 189.98 6035301200050860
page 1 of 5 TX 7 DI1 0 000 0 TOR
1
BUSINESS ACCOUNT
EEEFi
0000263
ACCOUNT SU RY z6035,3012 0 0 050 86 0
Previous Balance 3,155.46 Closing Date 01/20/10
Payments 0. 00 Next Closing Date 02/17/10 CARMEL STREET DEPT
Credits 0.00 Payment Due Date 02/14/10 CINDY
Purchases 679.83 3400 W 131ST ST
Debits 0.00 Current Due 679.83 WESTFIELD, IN 46074 4267
FINANCE CHARGES 0.00 Past Due Amount 3,155.46 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 3,835.29 Credit Available 1 ,414
New Balance 3,835.29
CURRENT ACTIVITY
Trar►saa on L ocatia if 10,..x.; Amount
IN Date t� rclSCrlotlOn r' f4z .�ny _....x.
DEC 29 GOODS AND SERVICES WESTFIELD IN 298.65
JAN 5 GOODS AND SERVICES WESTFIELD IN 25.94
JAN 7 GOODS AND SERVICES WESTFIELD IN 20.78
JAN 8 GOODS AND SERVICES WESTFIELD IN 34.31
TOTAL 6035301200074803 $379.68
JAN 4 GOODS AND SERVICES WESTFIELD IN 149.99
TOTAL 6035301202895874 $149.99
JAN 6 GOODS AND SERVICES WESTFIELD IN 91.60 F C`
TOTAL 6035301202895932 $91.60
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 .00533 33 0.00 0.00 .00000 30 0.00
This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1- 800- 559 -8232 FAX NUMBER 1 -801- 779 -7425
page 2 of 5 TX 7 D1130000000
TRACTOR
SUPPLY Co,
BUSINESS ACCOUN
0000264
CURRENT ACTIVITY
Marls act ion LocatiotV
k g�
DEC 30 GOODS AND SERVICES WESTFIELD IN 39.99
TOTAL 6035301202895999 $39.99
JAN 11 GOODS AND SERVICES WESTFIELD IN 6.58
TOTAL 6035301202896013 $6.58
JAN 6 GOODS AND SERVICES WESTFIELD IN 11.99
TOTAL 6035301202896138 $11.99
Did you overlook your payment to us? If
so, please send the amount due today. If
payment is in the mail thank you!
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 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 I I I RACIDR
M DEPT.30 1200050860 JEFF STEWAR7
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000265
Payment Due Date: 02/14/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
0 SHIP TD: INVOICE: SHIP TD INVOICE:
431000990748010 431000992449010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 298.65 AMOUNT DUE: 25.94
Store: 574000431 INVOICE DATE: 12/29 /09 Store: 574000431 INVOICE DATE: 01/05 /10
YW SURE SOFT PELTS 40LB 2189761 63.00 4.74 298.62 G8 GALV AND COTTERPIN B 3568887 6.50 3.99 25.94
SUBTOTAL 298.62 SUBTOTAL 25.94
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 298.65 TOTAL 25.94
i.,
J
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000993115010 431000993165010
Purchase Order: Purchase Order:
SHOP 10810
AMOUNT DUE: 20.78 AMOUNT DUE: 34.31
Store: 574000431 INVOICE DATE: 01/07 /10 Store: 574000431 INVOICE DATE: 01/08 /10
05 BULK SELLING SKU 3555559 6.95 2.99 20.78 08 GALV AND COTTERPIN B 3568887 8.60 3.99 34.31
SUBTOTAL 20.78 SUBTOTAL 34.31
TAX 0.00 TAX 0.00
SHIPPING 0- 00_.._ SHIPPING 0.00
TOTAL 20.78 TOTAL 34.31
\O
Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425
Remit To: Bill To: page 4 of 5
=o TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TRACTOR'
m DEPT.30 1200050860 JAMES BENTLEY SUPPLYC°
=o PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000266
Payment Due Date: 02/14/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO INVOICE: SHIP TO INVOICE:
zzzz 431000992088010 431000992888010
Purchase Order: Purchase Order:
1042010 CARMELFIREBOBV
AMOUNT DUE: 149.99 AMOUNT DUE: 91.60
Store: 574000451 INVOICE DATE: 01/04 /10 Store: 574000451 INVOICE DATE: 01/06 /10
SHOE LTHR 9 IN 11 BN RW 7087809 1.00 149.99 149.99 HAIRPIN COTTER .178 7/8 1835430 1.00 0.99 0.99
HAIRPIN COTTER .178 7/8 1833430 1.00 0.99 0.99
SUBTOTAL 149.99 HAIRPIN COTTER .178 7/8 1833430 1.00 0.99 0.99
TAX 0.00 HAIRPIN COTTER .178 7/8 1833430 1.00 0.99 0.99
SHIPPING 0.00 TSC CLEVIS 3/41N SCREW 0268072 1.00 14.99 14.99
TSC CLEVIS 3/4114 SCREW 0268072 1.00 14.99 14.99
TOTAL 149.99 HOOK 5/16IN CLEVIS GRAB 5586657 1.00 8.49 8.49
HOOK 5 /16IN CLEVIS GRAB 5586657 1.00 8.49 8.49
CHAIN 5/16 GR70 TRANSPO 558641.1 6.00 5.79 22.74
TSC HITCH TSC PIN 5/8114 0268802 1.00 4.99 4.99
TSC HITCH TSC PIN 5/8)14 0268802 1.00 4.99 4.99
TSC PIN 5/16)(2 -1 /4IN PT 0268755 1.00 1.99 1.99
TSC PIN 5/16)(2 -1 /4IN PT 0268755 1.00 1.99 1.99
TSC PIN 5/1602 -1 /4IN PT 0268755 1.00 1.99 1.99
TSC PIN 5/1602 -1 /4IN PT 0268755 1.00 1.99 1.99
SUBTOTAL 91.60
TAX 0.00
SHIPPING 0.00
TOTAL 91.60 0
C
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000990953010 431000993890010
Purchase Order: Purchase Order:
123009 1112010
AMOUNT DUE: 39.99 AMOUNT DUE: 6.58
Stare: 574000431 INVOICE DATE 12/30 /09 Store: 574000431 INVOICE DATE 01/11 /10
BOOT LTHR INS PAC 10 BN 7391680 1.00 59.99 39.99 G8 GALV AND COTTERPIN B 5568887 1.65 5.99 6.58
SUBTOTAL 39.99 SUBTOTAL 6.58
TAX 0.00 TAX 0.00
SHIPPING 0.00 _SHIPPING- -0..00
TOTAL 39.99 TOTAL 6.58
6
b
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
Remit To: Bill To: page s of 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TRACTOR
DEPT.30 1200050860 TRAVIS TABAK 7 SUPPLY CP
PO BOX 689020 3400 W 131ST ST BUSINESS ACCOU
DES MOINES IA 50368 -9020 0000267
Payment Due Date: 02/14/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TD INVOICE:
moo 431000987089010 431000992757010
Purchase Order: Purchase Order:
SHOP TRUCK204
AMOUNT DUE: 144.57 AMOUNT DUE: 11.99
Store: 574000431 INVOICE DATE: 12/17 /09 Store: 574000431 INVOICE DATE: 01/06 /10
CHAIN 03 DOUBLE LOOP 3592064 85.00 0.79 144.57 TSC WHEEL SPINNER RD 0291318 1.00 11.99 11.99
SUBTOTAL 144.57 SUBTOTAL 11.99
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 144.57 TOTAL 11.99
1
a
'N
Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425
RRE TTSC BUSINESS ACCOUNT
Tc 1 'RACTOR PAYMENTS ONLY TO:
TRACTOR SUPPLY COMPANY
SY P.O. Box 68902 Tractor SuPPly ComPanv
Des Moines, IA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ie1d' IN 46074
(6035 301# 317) 867
NAME CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(31?) 733 -2001
CITY STATE ZIP PHONE 431 431000172 2 990748
12/29/2009 11:53am
CUSTOMER TO COMPLETE 2189761 YW SURE SOFT PELTS 4
63.00 R 4.74 298,65 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res, Price: 4,99
The undersigned certifies The undersigned party certifies their exemption from Government Asencies
compliance with the agricultural payment of sales and use tax on tangible persona(
sales tax exemption law of the state property as indicated below and /or purchaser is Subtotal 298.65
indicated below and understands engaged in the business of agricultural production of 7.00y Tax 0.00
and agrees with the General Total 298.65
food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and TSC Card 298.65
the applicable statement of the resale and /or uses the farm machinery, equipment or Acct.: I: s s: t t t t t t t 4803
respective state printed on the other agricultural production items purchased free of Auth$:029970 Ref. :2910532508
reverse side of this form. tax, as defined by state law, and as indicated below. PO .;shop
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Chanse 0,00
understand they be liable for payment of all taxes Cash Back
Y ma Y P Y
STATE:
(REQUIRED) due on the purchase price for the goods as allowed by
(Exceptions: Georgia, New York &Kentucky state law should such g oods be used or consumed in Buyer acknowledse5 the receirt of a comrle
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws. cony of this sales slip and the Purchase o
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in the described merchandise shall be in
Exempt organization every material manner. A willfully false representation accordance with the Cardholder Agreement,
Agricultural Production of exemption will cause the purchaser to be subject to
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production Signature:
Floriculture /Aguaculture Production law
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity h i l t t: t ::I A t i l t*: t: t t t t i t t t t t t t t t t t
Livestock Injestibles or Injectibles Exempt Organization (Entity t:I: t 3 t: t t I t t i t t t I I::I t I I t t t t I t t:I t t:
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Call 800 -968 -0734 within 7 days to in a
a Consumed in Production (KS)
Resale (Sales Tax Permit monthly chance e to d win a
Ingredient or Component Parts (KS) 32500 ShoPPins spree.
(Awarded as Gift Card) NO PURCHASE
Other: OR SURVEY NECESSARY. Ends 9/30/10.
tII I IIIt :ISIt:tSMSStt :I :Ittttttttt
CUSTOMER SIGNATURE(REQUtRED MGR. APPROVAL
Y USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. J
CASH' CHECK VISA i s M/C D4SCOVER :TSC CHARGE ACCOUNT NO, 4: CHG 4` EXCH. t :DATE,'
s e
p,s
z
e.
QUANTITY ITEM NUMBER TA
x D ESCRIPTION SNIT PRICE
Form No. 99 -00401 (12/48) CUSTOMER ORIGINAL
REMIT TSC [BUSINESS ACCOUNT
TS TRA PAYMENTS ONLY TO:
CTOR TRACTOR SUPPLY COMPANY
P.O. Box 689020
Des Moines, IA 50368 Tractor SUPPLY CQmPanY
18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield. IN 46074
(6035 301 (317) 867
NAME
CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 431000182 2 992449
01/05/2010 03:10Pm
CUSTOMER TO COMPLETE 3568887 G8 GALV AND COTTERPI
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 6.50 P A en 25.94 NT
ned certifies Government Asenciea
The undersigned The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 25,94
sales tax exemption law of the state property as indicated below and /or purchaser is 7.00: Tax 0.00
indicated below and understands engaged in the business of agricultural production of Total 25.94
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for T5C Card 25.94
Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct I t I t x 4803
the applicable statement of the other agricultural production items purchased free of Authi :00563t t::5 Refs :0514103722
respective state printed on the PO:shaP
tax, as defined by state law, and as indicated below.
reverse side of this form. Change 0.00
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back
STATE: understand they may be liable for payment of all taxes
(REQUIRED) due on the purchase price for the goods as allowed by_ Buyer acknowledges the receipt of a come le
COMPLETE REVERSE SIDE Kentucky state law should such goods be used or consumed r
a taxable manner as defined by state laws. copy Of this sales slip and the Purchase o
PURCHASER IS ENGAGED IN: (REQUIRED) f
Resale Under penalty of perjury, signee swears the the described merchandise shall be in
Govemment information on this statement is true and correct in Pc.cordance with the Cardholder Agreement.
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 provisions as allowed under state Signature:
Livestock Production
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
s2:33313tittttt Sit #3ttt234:3l3tssttt3
Farm Machinery/Repair Parts Government Agency (Entity it$$ ttt :ftttItttttittttittttf31223211I
Livestock Injectibles or Injectibles Exempt Organization (Entity Call 800 -968 -0734 within 7 days to
Fertilizer /Agnchemicals NC: only DOT and US Govemment are exempt complete a Survey and be entered in a
R esale (sales Tax Permit monthly drawing for a chance to win a
Consumed in Production (KS) $2500 ShoPPins spree.
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
0 Other. OR SURVEY NECESSARY. Ends 9/30/10,
3333ttt :Iltttttt33:tttlititlltttlii23
USTOM R S!.- NATURE: (REQUIRED) MGR. APPROVAL
1 i c)
x
�a
rr if USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
A' E`, CHECKS VISA M/C DISCOVER TSC CHARGE ACCOUNT NO y 'CHG EXCH DATE
QUANTITY ITEM NUMBER, TAX DESCRIPTION ■NIT PRICE
FonnNo. 99 -00401 (12/08) CUSTOMER ORIGINAL
n n p� ACCOUNT
e• s.,."a::fz.m�xz�,.'f'?,..:
REMIT TSC l USDNESS ACCOUNT
�r PAYMENTS ONLY TO:
lift TRACTOR TRACTOR SUPPLY COMPANY
S IJPPI 1YC0 P.O. Box 689020 Tractor SUPPLY Cooe any
Des Moines, IA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield, IN 46074
(6035 301# (317) 867
NAME CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 431000172 2 993115
01/07/2010 07:OBPm
CUSTOMER TO COMPLETE 3555559 G5 BULK SELLING SKU
6.95 2.99 20.78 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 20,78
sales tax exemption law of the state property as indicated below and /or purchaser is 7.00 Tax 0.00
indicated below and understands engaged in the business of agricultural production of Total 20.78
and agrees with the General TSC Card 20.78
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Acct*: i t i i i i i t t i i i 4803
the applicable statement of the resale and /or uses the farm machinery, equipment or Autht:007508 Ref*:0718080620
respective state printed on the other agricultural production items purchased free of FO :shop
reverse side of this form. tax, as defined by state law, and as indicated below. Chanse 0.00
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back
STATE: understand they may be liable for payment of all taxe Surer acknowledses the receipt of a comrle
(REQUIRED) due on the purchase price for the goods as allowed ti
(Exceptions: Georgia, New York a Kentucky state law should such g oods be used or consumed in
COMPLETE REVERSE SIDE) COPY of this sales slip and the Purchase o
a taxable manner as defined by state laws. f
PURCHASER IS ENGAGED IN: (REQUIRED) perjury, g the described merchandise shall be in
p
Resale Under penalty of er'u ry signee swears the accordance with the Cardholder Asreement.
Govemment information on this statement is true and correct in
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 provisions as allowed under state 5isnature:
Livestock Production
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR :(REQUIRED) tttitttiiiiitttiiiiiifitiitiiitiiiiti
Farm Machinery/Repair Parts GovemmentAgency(Entity# iiiitiiiiiittitiitititiifitifiiiiti ii
Livestock Injestibles or Injectibles Exempt Organization (Entity Call 800 968 -0734 within 7 days to
Fertilizer /Agrichemicals NC: only DOT and US Govemment are exempt complete a survey and be entered in a
Resale (Sales Tax Permit
Consumed in Production (KS) monthly drawins for a chance to win d
$2500 shoppins spree.
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/10.
Other: iii itiiiti tiitiiittiiiitii2****2*ttii
C) eld R IGNATURE: (REQUIRED' MGR. APPROVAL
1 ao� X
1 .7 li USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
S CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
QUANTITY ITEM NUMBER NON DESCRIPTION INIT PRICE
TAX
Form No. 99-00401 (12/08) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS ONLY TO:
T TRACTO R TRACTOR SUPPLY COMPANY
S V iox 689020 Y P.O.
f Tractor Supply Cowan
Des Moines, IA50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wes tf 7eld. IN 46074
(6035 301# (317) 867-3505
NAME CARMEL STREET DEFT
3400 11 131ST ST
ADPRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 786000104 2 993165
01/08/2010 11:29am
CUSTOMER TO COMPLETE 3568887 G8 GALV AND COTTERFI
8.60 8 3.99 34.31 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural Subtotal 34.31
payment of sales and use tax on tangible personal
sales tax exemption law of the state property as indicated below and/or purchaser is 7.007. Tax 0, 00
indicated below and understands engaged in the business of agricultural production of Total 34.31
and agrees with the General TSC Card 34.31
food -or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and Ac c t>k t i t i t i i i s i# i 4803
resale and /or uses the farm machinery, equipment or
the applicable statement of the Autht:008063 Ref #:0810284622
respective state printed on the other agricultural production items purchased free of FO $:010810
reverse side of this form. tax, as defined by state law, and as indicated below. Chanse 0.00
I W
PRODUCT ts rerse U FD IN T OLLOWG The undersigned party further certifies they Cash Back
understand the may be liable for pa of all taxes
STATE: '1I^ OK t T
Buyer acknowledses the receipt of a cDntPle
(REQUIRED) due on the purchase price for the goods as allowed bye
(Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in
COMPLETE REVERSE SIDE) a taxable manner as defined by slate laws. copy of this sales slip and the Purchase o
f
PURCHASER IS ENGAGEDIN:(REQUIRED) the described merchandise shall be in
Resale Under penalty of perjury, signee swears the accordance with the Cardholder Rsreemen t
'Government information on this statement is true and correct in
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 provisions as allowed under state Sisna tune:
Livestock Production
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) ii# i##i #Xt# #ii ###i#ttittt ##ii##
Farm Machinery/Repair Parts Government Agency (Entity 1 ii## t#tiiitttiitiiiii#itiiiti#t #t #i
Livestock In estibles or In edibles Call 800-968 -0734 within 7 days to
1 I Exempt Organization (Entity complete a survey and be entered in a
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit monthly 2500 shoprird spree.
s for a chance to win a
3 $2500
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/10.
Other. of 2t2# ####t###t#t ##122tiMi#i##i
STO E` NATURE:(REQWRED) MGR. APPROVAL
i)) t. )I USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH' CHECK VISA M/C` "u DISCOVER,. TSC CHARGE ACCOUNT NO, s, r. a .x 4 CHG. x DATE
E H.
QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE
Form No. 9900401 (12/08) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS ONLY TO:
T r i i ACThR TRACTOR SUPPLY COMPANY
:y ,4 V P.O. Box 689020 Tractor Supply Company
Norm Des Moines, IA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number We (3t eld, IN 46074
3460
(6035 301#
NAME CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 431000172 2 990953
12/30/2009 10:20am
CUSTOMER TO COMPLETE 7391680 BOO T LTHR INS PAC 10
1.00 P 39.99 39.99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Reg. Price: 49.99
The undersigned certifies The undersigned party certifies their exemption from Government Agencies
compliance with the agricultural payment of sales and use tax on tangible personal
sales tax exemption law of the state property as indicated below and /or purchaser is Subtotal 39.99
indicated below and understands engaged in the business of agricultural production of 7.00: Tax 0.00
and agrees with the General Total 39.99
food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and TSC Card 39.99
resale and /or uses the farm machinery, equipment or
the applicable statement of the Acctti:ittitiisitt#5999
respective state printed on the other agricultural production items purchased free of Authl :030985 Ref0:3009192941
reverse side of this form. tax, as defined by state law, and as indicated below. pO 123009
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Change 0.00
may be liable for payment of all taxes Cast, Back
understand they Y y p y
REQUIRED) due on the purchase price for the goods as allowed by Buyer acknawledeea the receipt of a comp le
(Exceptions: Georgia. New York Kentucky state law should such goods be used or consumed
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy
PURCHASER IS ENGAGED IN: (REQUIRED)
COPY Of this Sales Slip and the Purchase O
Resale Under penalty of perjury, signee swears ttfe the described merchandise shall be in
Government information on this statement is true and correct in
Exempt organization every material manner. Awillfully false representation accordance with the Cardholder Agreement.
Agricultural Production of exemption will cause the purchaser to be subject to .4
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production Signature:
Floriculture /Aquaculture Production law.
CI Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity it #t#t #tit #ttttit# ##t#t##ttittttttt#
Livestock Injestibles or Injectibles Exempt Organization (Entity 2# t t# t# i i t t i t i i t t t i t i t i t t t t 2 t i# i t i t i#
FeAilizer /Agrichemicals NC: only DOT and US Government are exempt Call 800- 968-0734 within 7 daps to
Resale(SalesTaxPermit# complete a survey and be entered in a
Consumed in Production (KS) monthly drawing for a chance to win a
Ingredient or Component Parts (KS) $2500 sfloPPin9 Spree.
(Awarded as Gift Card) NO PURCHASE
Other: OR SURVEY NECESSARY. Ends 9/30/10.
t itiii stitiisitiitiiiittiiiittittiiii
CUSTOMER SIGNATURE:(REOUIRED) MGR. APPROVAL
X
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH tg- CHECK' VISA MIC DISCOVER` JSCCHARGEACCOUNTNO C HG EXCH DATE
QUANTITY ITEM NUMBER TAX DESCRIPTION 4 UNIT PRICE
Form No 99 -00401 (12/08) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS ONLY TO:
11317 TRACTOR TRACTOR SUPPLY COMPANY
stn, sl P.Q. Box 689020
Tractor Supply Company
Des Moines, lA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf field, IN 46074
(6035 301# (317) 867 -3505
NAME CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 431000172 2 993890
01/11/2010 10:24am
CUSTOMER TO COMPLETE 3568887 G8 GALV AND COTTERPI
1.65 3,99 6.58 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Agencies
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural Subtotal 6.58
sales tax exemption law of the state payment of sales and use tax on tangible personal 7.00 Tax 0.00
property as indicated below and /or purchaser is
indicated below and understands engaged in the business of agricultural production of Total 6 58
and agrees with the General TSC Card 6.58
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Acct 2########2##6013
the applicable statement of the resale and /or uses the farm machinery, equipment or Auth *:011907 Ref *:1109243643
respective state printed on the other agricultural production items purchased free of PO *:01112010
reverse side of this form. tax, as defined by state law, and as indicated below. Chance 0.00
Th undersigned party further certifies they Cash Back
ers
PRODUCT IS TO BE USED IN THE FOLLOWING g p y
STATE: understand they may be liable for payment of all taxe Buyer acknowledses the receipt of a cons e
(REQUIRED) due on the purchase price for the goods as allowed br
(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. COPY of this sales slip and the purchase o
f
PURCHASER IS ENGAGEDIN:(REQUIRED) the described merchandise shall be in
Resale Under penalty of perjury, signee swears the accordance with the Cardholder Agreement,
Government information on this statement is true and correct in
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 provisions as allowed under state S isnature:
Livestock Production
Floriculture /Aquaculture Production law
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) 2 #2: #2222 :2 :21122# #2# :#t
Farm Machinery/Repair Parts GovemmentAgency(Entity 2 #2222 #22 #2222:::22#: :22122
L ivestock Injestibles or Injectibles Call 800 968 -0734 within 7 days to
i i Exempt complete a survey and be entered in a
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt
Resale (Sales monthly drawing for a chance to win a
Consumed in Production (KS) $2500 shorPins spree,
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY, Ends 9/30/10.
Other: 222222:2 32322::#22#:::ttt2#t #222211#
CUSTOMER SIGNATU E :rREQUIRED) MGR. APPROVAL
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATNE.
CASH CHECK SA WC DISCOVER TSC CHARGE ACCOUNT NO. 4, CHG. 'IEXCH. PATE'
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QUANTITY ITEM NUMBER NON DESCRIPTION UNIT PRICE
Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
Trst PAYMENTS ONLY TO:
TR ACTOR SUPPLY COMPANY
SUPPLY P.O. Box 689020 Tractor Supply Camt'any
Des Moines, IA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West +ield, IN 46074
(6035 301# (317) 867-3505
NAME CARMEL STREET DEPT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 431 431000187 2 992757
01/06/2010 02 :59pm
CUSTOMER TO COMPLETE 0291318 TSC WHEEL SPINNER RD
1.00 11.99 11,99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agriculturalSubtotal 11,00
payment of sales and use tax on tangible personal
sales tax exemption law of the state property as indicated below and /or purchaser is Total Tax 0
indicated below and understands Total 11.99
engaged in the business of agricultural production of
and agrees with the General T Card 11.99
food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and Acct$, tt: ::tt:t #:#6138
resale and /or uses the farm machinery, equipment or
the applicable statement of the other agricultural production items purchased free of Authtbt006948 Ref O91 355'0810
respective state printed on the g p p PO �:7RUCK 204
reverse side of this form. tax, as defined by state law, and as indicated below. Chance 0.00
The undersigned party further certifies they Cash Back
PRODUCT 1$ TO BE USED IN THE FOLLOWING 9 P Y Y
STATE: understand they may be liable for payment of all taxes
(REQUIRED) due on the purchase price for the goods as allowed byed Burer acknowledses the receipt of a cDmle
(Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy of this sales slip and the purchase o
f
PURCHASER IS ENGAGED IN: (REQUIRED) the described merchandise shall be in
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in accordance with the Cardholder Agreement.
El 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 provisions as allowed under state Sisnature:
Livestock Production
Floriculture /Aquaculture Production law
0 Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
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Farm Machinery/Repair Parts Government Agency (Entity t 11: L: t t: t t i t t i t t i t t# t t t t t L 1: t t t# t t t
ID Livestock Injestibles or Injectibles Exempt Organization (Entity Call 800-968 -0734 within 7 days to
ID Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a
ID Consumed in Production (KS) Resale (Sales Tax Permit
monthly drawing for a chance to win a
$2500 shoppins spree.
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/10.
Other: titISMlt tit:ti:t:t ##ttttSSMSttttt
CUSTOMER SIGNATURE: (RED "ED *y MGR APPROVAL PPW £JAL
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USE SHADED AREA ONLY WHEN REGISTER IS INOPERATNE. w
CASH M„ CHECK w VISA M/C „DISCOVER TSC CHARGE ACCOUNT NO. CMG' EXCH. DATE
QUANTITY ITEM NUMBER NON X DESCRIPTION UNIT PRICE
Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL
t REMIT TSC BUSINESS ACCOUNT
M ENTPAYMENTS ONLY T
TRACTOR SUPPLY COMPANY
e P.O. Box 689020 Tractor Supply Company
SUPPL Des Moines, IA 50368 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Westf ield6 IN 46074
Please include 16 Digit Account Number (317) 867 3505
(6035 301
NAME CARMEL STREET DEPT
3400 W 131ST ST
WESTFIELD IN 460748267
ADDRESS (317) 733 -2001
CITY STATE ZIP PHONE 431 431000172 2 992088
01/04/2010 10:11am
CUSTOMER TO COMPLETE 7087809 SHOE LTHR 9 IN 11 BN
1,00 149,99 149.99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Agencies
The undersigned certifies The undersigned party certifies their exemption from Subtotal 149,99
compliance with the agricultural payment of sales and use tax on tangible personal 7.004 Tax
sales tax exemption law of the state property as indicated below and/or purchaser is 0.00
indicated below and understands Total 149.99
and agrees engaged in the business of agricultural production of TSC Card 149.99
an rees with the General food or fiber, horticulture, aquaculture of floriculture for Acctx: t t t 6 6 t t z t -5874
Exemption e r applicable Statement
sttt emright e and the
statement of and resale and /or uses the farm machinery, equipment or Auth #:004522 Ref *:0409113508
respective state arm ed on the other agricultural production items purchased free of PO :01042010
reverse side of this form. tax, as defined by state law, and as indicated below. Chance 0.00
Thdi n Cash Back
The undersigned PRODUCT IS TO BE USED IN THE FOLLOWING g ed party further certifies they
STATE: understand they may be liable for payment of all taxes Buyer acknowledges the receipt of a alike
(REQUIRED) due on the purchase price for the goods as allowed tad
(Exceptions: Georgia, New
COMPLETE REVERSE SID York Kentucky state law should such goods be used or consumed in COPY of this sales slip and the Purchase o
a taxable manner as defined by state laws. f
PURCHASER IS ENGAGED IN: {REQUIRED) the described merchandise shall be in
Resale Under penalty of perjury, signee swears the accordance with the Cardholder Agreement.
Government information on this statement is true and correct in
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to Signature:
Dairy Production penalty and/or other provisions as allowed under state
Livestock Production
Floriculture /Aquaculture Production law.
Other:
ITEMS PURCHASED WILL BE USED FOR:( REQUIRED) Itt##2231t#ttt- tt6- tit666ttt#6662#323
Farm Machinery/Repair Parts Government Agency (Entity ItEtttit0 #968- 0#3tttttttnt7t#ttttt -It
Call 800 968 -0734 within 7 days to
Livestock Injectibles or Injectibles Exempt Organization (Entity complete a survey and be entered in a
F ertilizer /A nchemicals NC: only DOT and US Govemment are exempt
g monthly drawing fora chance to win a
Consumed in Production (KS) Resale (Sales Tax Permit $2500 shopping spree
(Awarded as Gift Card) NO PURCHASE
Ingredient or Component Parts (KS) OR SURVEY NECESSARY. Ends 9/30/10.
Other; Shit ##t#t#t66- t26##tit##t##ttt61662
CUS E SIGNAATURE:(REOU D) MGR. APPROVAL
1 7.
USE SHADED AREA ONLY WHEN, REGISTER IS INOPERATIVE.
CHG V EXCH. DATE
CASH CHECK VISA M/C 'DISCOVER -TSC CHARGE ACCOUNT NO r
0 0 0 Li-
QUANTITY ITEM NUMBER TAX DESCRIPTION UNIT PRICE
Form No. 99 -00401 {72/08) CUSTOMER ORIGINAL Wi
VOUCHER NO. WARRANT NO.
ALLOWED 20
Tractor Supply
IN SUM OF
P. O. Box 9020
Des Moines, IA 50368 9020
$588.23
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member
2201 42- 389.00 $298.65 I hereby certify that the attached invoice(s), or
2201 43- 560.03 $189.98
bill(s) is (are) true and correct and that the
2201 42- 370.00 $99.60
materials or services itemized thereon for
2 1 0 1 (7. which charge is made were ordered and
received except
ThursidIy, a ry 28, 201C
/(1 'a 1 vv 1
Street Commission -r
Crrc -f fnmmi.ssinner
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))
01/28/10 $298.65
01/28/10 $189.98
01/28/10 $99.60
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