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HomeMy WebLinkAbout183025 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $37.85 CARMEL, INDIANA 46032 PO BOX 689020 «o �.o DES MOINES IA 50368 -9020 CHECK NUMBER: 183025 CHECK DATE: 3/3/2010 DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 STREET 37.85 6035301200050860 yco- 0000281 BUSINESS ACCOUNT 6 s r��`ff M�Mp AAAA Zg ■,���iiiaxn�. f {�.s g r .s amp: ALCGQUN��Si1AflM;I�1RY���� YY��� �p�` t _s �����F� 3 �5�`ax$g �a f.___:: Previous Balance 3,835.29 Closing Date 02/17/10 Payments 3,223.03 Next Closing Date 03/19/10 CARMEL STREET DEPT Credits 0.00 Payment Due Date 03/14/10 CINDY Purchases 307.84 3400 W 131ST ST Debits 0.00 Current Due 307.84 WESTFIELD, IN 46074.8267 FINANCE CHARGES 0.00 Past Due Amount 612.26 Credit Line 5,Z50 Late Fees 0.00 Minimum Payment Due 920.10 Credit Available 4,329 New Balance 920.10 CURRENT ACTIVITY 2' a w .*m Yz:. T 4 -u b .,ff•,� ^t s 7 ,M't 4z T4 l g8CtsOn e l ocaif W. a x WRE! t19t4� a rt ARIOtIn� llla s. JAN 29 GOODS AND SERVICES WESTFIELD IN 36.56 FEB 2 GOODS AND SERVICES WESTFIELD IN 1.29 TOTAL 6035301200074803 $37.85 JAN 22 GOODS AND SERVICES WESTFIELD IN 269.99 TOTAL 6035301202896062 $269.99 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS JAN 22 PAYMENT REF P91940OD809FR597E 3,223.03 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daly Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Billing PERCENTAGE Subject to Periodic Blkng PER Finance C+targa Rata Panod RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 28 0.0o 0.00 .00000 33 0.00 This Acc ount Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1- RQf 2 FAX NUMBER 1 -801- 779 -7425 w SUFMCO2 BUSINESS ACCOUNT �.0 0000282 -4 CURRENT ACTIVITY �g 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. DEPT.30 1200050860 JEFF STEWART S YCO- PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000263 Payment Due Date: 03/14/10 Please make checks Payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP To: INVOICE: 431000992449010 431000993115010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 25.94 AMOUNT DUE: 20.78 Store: 574000451 INVOICE DATE: 01105/10 Store: 574000451 INVOICE DATE: 01/07110 G8 GALV AND COTTERPIN B 3568887 6.50 5.99 25.94 G5 BULK SELLING SKU 5555559 6.95 2.99 20.78 SUBTOTAL 25.94 SUBTOTAL 20.78 TAX 0.00 TAN 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 25.94 TOTAL 20.78 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000993165010 431000997539010 Purchase Order: Purchase Order: 10810 WASH BAY AMOUNT DUE: 34.31 AMOUNT DUE: 36.56 Store: 574000431 INVOICE DATE: 01106 110 Store: 574000431 INVOICE DATE: 01/29/10 66 GALV AND COTTERPIN B 3568887 8.60 5.99 34.31 QUICK COUPLER 2IN PART 2121666 1.00 6.29 6.29 QUICK COUPLER 2IN PART 2121656 1.00 11.99 11.99 SUBTOTAL 54.31 QUICK COUPLER 2IN PART 2121682 1.00 6.29 6.29 TAX 0.00 QUICK COUPLER 2IN PART 2121640 1.00 11.99 11.99 SHIPPING- 0:00- SUBTOTAL 56.56 TOTAL 54.31 TAX 0.00 SHIPPING 0.00 TOTAL 36.56 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 -779 -7425 DEPT.30 1200050860 JEFF STEWART S YC p PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000284 Payment Due Date: 03/14/10 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN e� �a SHIP TO: INVOICE: SHIP TO: INVOICE: 431000998598010 431000996091010 Purchase Order: Purchase Order: SHOIP ENGINEERINGDEPT AMOUNT DUE: 1.29 AMOUNT DUE: 269.99 Store: 574000431 INVOICE DATE: 02102 /10 Store: 574000431 INVOICE DATE: 01122 /10 MALE 3 /4XI /2 HOSE BARB 2108927 1.00 1.29 1.29 TSC TBR BET ALUM FS SGL 1091753 1.00 269.99 269.99 SUBTOTAL 1.29 SUBTOTAL 269.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 1.29 TOTAL 269.99 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 -779 -7425 �REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY C O W P.O. Box 689020 Tractor Supply Company Des Moines, IA 50368 10160 U. 31 Nor TSC TEAM MEMBER TO COMPLETE Westf IN 46074 Please include 16 Digit Account Number f317) 867 -3505 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733'-2001 CITY STATE ZIP PHONE 431 431000189 2 997539 01/29/2010 10:20am CUSTOMER TO COMPLETE 2121666 QUICK C O U PLER 2I PA 1,00 6.29 6,29 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from 2121658 QUICK COUPLER 2IN PA compliance with the agricultural 1.00 11 .99 11 .99 NT payment of sales and use tax on tangible personal sales tax exemption law of the state Government Asencies indicated below and understands property as indicated below and/or purchaser is 2121682 QUICK COUPLER 2IN PA engaged in the business of agricultural production of and agrees with the General 1.00 6.29 6,29 NT food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the.farm machinery, equipment or Government Asencies the applicable statement of the other agricultural production items purchased free of 2121640 QUICK COUPLER 2IN PA respective state printed on the 1 .00 2 11 .99 11 ,99 NT reverse side of this form, tax, as defined by state law, and as indicated below. Government Asencies PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Subtotal 36.56 STATE: understand they may be liable for payment of all taxes 7 00% Tax 0.00 J (REQUIRED) due on the purchase price for the goods as allowed by Total 36, 56 COMPLETE REVE SIDE) OE B, New s Ke ntuck y state law should such goods be used or consumed in COMPLETE REVE TSC Card 36.56 a taxable manner as defined by state laws. Acct J J J J 4803 PURCHASER IS ENGAGED IN: (REQUIRED) 5 Ref 2909200342 F1 Resale Under penalty of perjury, signee swears the PO #:laashbar Government information on this statement is true. and correct in anew 0.00 F Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Cash Back Dairy Production penalty and /or other. provisions as allowed under state Livestock Production Buyer acknowledses the receipt of a comple Floriculture /Aquaculture Production law' te Other: copy of this sales s lip and the Purchase o.• ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) the described merchandise shall be in Farm Machinery /Repair Parts Government Agency (Entity I accordance with the. Cardholder Asreement Livestock Iniestibles or Iniectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Sisnature: Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: STO R SIGNA REQUIRED) aGR1,'1ROVAL z qt IN USE SHAD ONLY WHEN REGISTER. IS CASH CHECK VISA 'M!C DlSGOVER TSC G RGE ACCOUNT NO. CHG EXCH; DATE p a, Xv ITEM r NUMBE DESCRIPTI Form No. 99 -00401 (12io8) CUSTOMER ORIGINAL ARKANSAS"The3 cUStaf'ner', as indicated by their stgnat-a oil the reverse, Certifies that heishe is engaged In the business of farming and Ill. farm machinery and equ,pn tit purchased will be a e[l exclusively and directly in the agri LIQural prodf srti'rah of food or fiber as a business. F he reverse signed Is awar. that any false rep­s.snfat made by there in ties attempt to purcrra Se f.,­ n—Orinary and egrApment free from Arkansas Sales Tax is a rnisdemeanor, GEORGIA: The roverso signed horcby certifies that all mrrgit le personal property purchased or taasod after the reverse indicated date will be purchased or leased for the purpose indicated below. unleS'S otherwise speoM00 o a particular order, and that the purchases a used as a part of a PUr it engaged In for pro fib. Tfsia 1- 0ficate ai'1a €l remain in effect until --kcal in writing- Any ti gib €e personal properly obtain th ed under is certrrk;ate p1 exemption is .:..0ject to the sates and use fax if ii is used orr consurnod by the purchaser in any manner other the« indleared On this certificate. (Check proper box. -FARM MACHINERY AND EQUIPMENT- 1 Rubber -tired term tractors and attaohmonis which will be used axcleu -.1y In tilling. planting, cu ltivating or harvesting fanTl L`rop5 tar safe. Such crops Will be plan ted and harvested within a twelve- nlanth period. O.C.G.A. 48- 8- 3(29)(f) 2. MaOhinery ahT.' .""'P72 which will be used On the faran directly in the production of poultry or eggs for sale. O.C.G.A. 48- 8- 3(29)(A) 3. Machinery and'or equipment which twill be used on the farm directly in the production, processinq or storage of fluid milk for sate. O.0 -G -A. 48- 8- 3(29)(C) 'I, Machinery andior eq.ipm of which w•iil be u3dd On the fart der —sly in the production of ve Stock for sale. O.C.G.A- 46 6- 3(29)(D) 5, Machinery ono %or equipment which -rf be used On the farm di —ally in harvestinq farm crops grown and �iserl on the farm as feed for pUUI[iy or live -stack try ;a prodtacer failing Under the categories 2, 3, or 4 above. O.0 -G -A. 41}- 8- 3(29)(E) Machinery and /or eq uipmont which will be used in the hatching and brooding of poultry and livestock for sale. O- C.G.A.. 48- 8- 3(29)(9) f 7. Mrschinery And. equi pmenf which will be used in filling the, soil or in animal husbandry. O.C.G.A. 48- 8- 3(29)(F) -(G) (H) e. Mnarlit,sly andrnr equip n met which will be usual exclusively for irrigation of farm crops grown for sale tncludin ve g, but not limited 10 fruit, vegetable and nut crops. O.0 -G -A.§ 48 -a -3(26) 9. Pecan —yeas, pecan shakers andior other equipment used in harvesting pectins. O.C.G -A- 48- 6- 3(29)(J) 10. Equipment which will be used on the farm cxclusive€y in processing on €ohs. O.C.G.A. 48- 8- 3(29)(1) TIMBER EQUIPMENT AND RELATED ATTACHMENTS- 11 Off -road equipment and related artachmrnis whl 1, will be used axctusfvafy i r t ins site preparation, planning. _u ltivatio n. or harvesting of timber. This shall include all off ruad eciu+ipma and related attach L sad I ery forestry procedure starting with the severing of a free from the ground until and including the point at which the tree or its parts in any farm has been loaded in the field in or on a ttuolr or other vehicle for transport to the place of use- O.C.G.A. 48 -8- 3(29).1 LIVESTOCK, SEED, FERTILIZER, FEED, PACKAGING. ETC 12_ Cattle, hogs. sheep. horses, poultry. and bees when sold for breading purposes. O.C.G.A. 48 -6 -3(28) 13. S.ed. Geedling5, fediii LElrS. insuclicades, fungicides, rodentir;ldes, herbicides, defoliant S. soil fumigants. plant growth regulating ohenllcals. d—i —milts includi,g shaving. and a wdusl. from wand, peanut hulls, fuller's earth. straw and hay) anti feed for livestock, fish or poultry When used either' directly In tilling the soil or in i nr Rl al, fish or poultry husbandry; andl r, r—o— turnabie materials used for packil'rg faro) products for shipment or sale. O.C.G.A. 48 3(25) (35) (A) (Eli) FUELS USED IN POULTRY STRUCTURES ELECTRICITY USED IN IRRIGATION OF FARM CROPS- 14. The sale of electricity for the operation at an irriyafien systerrl which is used on a farm exclusively for irrigation of farm crops when separately metered. O.C.G.A. 48 -6 -3(64) 15- LiquofE ed petroleum gas or fuel used in a structure En which broilers, pullets. or other poultry are raised when separately metered. O.C.G.A. 48 -a -3(49) ILLINOIS: The reverse signed hereby certifies that the property purchased will be used primarily En production aghcultUra or in Stale or Federal agriculture programs. Any farm chemicals purchased as exempt are SUCH pursuant to Section 130.1955. KENTUCKY: Ti­ reverse signed Yre+'eKsy csrtltiss that they a+'a a fernier regularly engaged in the occupation oL (farmer must Initial appropriate Iine(s)) tit €in9 and cultivating Iho sot€ fnr the production of crops: raising arid feeding livestock or oou'try the products of which Ordinarily constitute food for human consumption; Or raising and teeding fames, alpacas, ratites, f7.tfalo, or aquatic: organisms. The reverse signed also cortities that the tangible personal proporty purchased as indicated below will be, used for the axempf purpose(s) provided for under KRS 139.480. Farmer must fN1rIAL spproprlat. lirte(s)_ Baling twin, ana wire Farm chemicals Farm machinery. attachmont s and reps €rireplacemersl parts therefor Farm work stock Fetid and torrid additives Ga olive, speoi orr fuels, natural gas or liquefied petroleum gas Livestock orr poultry the p —ducis of witch ordinarily constitute food for human consumption Hato,,,. rfamas, alpacas, buffal Or aquatic organisms t Maclli ery, equipmell(, attacnment5 arrd repairlreplacr:m t parts therefor to be incorper arced into an oxis e —fare [,]rain /Sbybearl facility and poultry, iivestork. rant[:, llama, alpaca, or aqua culture faallilies" Seed or lafYEii2e1' Materials to be incorporated into the renovation or repair of a.l —isting on -farm grain/soybcan facilities and poultry, livestock, retire i €ama, alpaca, or equaculture facility. Water used in the production of crops as a bust nosy ar in the raising of IEvestock/po llby, ­kites, llamas. alpacas, buffalo aquatic organisms and. dairy, c.,attle. SEE REVERSE SIDE SEE REVERSE SIDE Signature Date MICHIGAN: The reverse signed hereby cortifies that all items, except as Indicated, am purchased for use or consumption En connection with the production at horticultural or agricultural products as a business enterprise• and agrees to reimburse the seller the sales tax it used or consumed otherwise. UnleWful use, of Ibis certifi�atu su bj,ois persons. to i Jenaltic-_s of the sales fax act. NORTH DAKOTA, SOUTH DAKOTA: The purchases made herein are subject to In$: reduced rate of sales tax and are not exempt from such tax. NEBRASKA: The reverse signed certifies the intended use of the items purchased renders it exempt under Reg. 1 -060 1-061 or 1- 06 .3. TEXAS CERTIFICATION OF EXEMPTION u r I, Purchaser's name SFE REVERSE SIDE Street Address SEE REVERSE SIDE City, state, zip code SEE REVERSE SIDE i claim an exernpiton from payment of solos and tine taxes for the purchase of taxable items described bolow or on the altac"d order or invoice: SEE REVER.S'E 51DE Description of Items (Or an attached order or Invoice) to be purchased: 4 r SEE REVERSE SIDE t I claim this exemption for the following reason: SEE REVERSE SIDE understand that 1 will be liable for paynnent of sales tax which may became due for failure to cornpiy with the provisions of the Tax Code: Limited Stiles. Excise= and Use Tor. Act. Mu cipai Sates arrd Use Tax Act, Sales end Usu Taxes for Special Purpose Taxing AuthUntlus, County Sales and Use Tax Ac1.,Couniy Health Services Sa €es and Usa Tex rand tree Texas Health and Safety Coate: Special Provisions Relating to Hospital Districts, Emergency Servic>_,s Districts, and Erergency Services Districts in unties with a pcpurat tin of 17-5, 000 or less. Lieblllty for file tax will be determined by the price paid for Ehe taxable items§ purchased .t the fair market rental value the period of time used. I understand that it is a llhlill.t offense to give an exemption certificate to the seller for taxable items which I know, at the time of purclease, will be used in a manner' Other than that expressed in this certificate. Sailer; SEE REVERSE SIDE Sf reet. address. SEE REVERSE SIDE City. state zip Coda: SEE REVERSE_ SIDE Purchaser's signature: 4EE REVERS S E S3DE Date: Phone: EV E Ti[le� SEE RRSIDE This nifieate does riot. roqui— a nurebef' to be valid. Sa1.�s and use tax exemption numbers or tax. exempt numbers do not exis This serf ifiGafe should be fulniyhad to the supplier. Do [tat ='send the completed certificate to the Comptroller Of Public• Accounts:. Effective Date: Seplembur '10. 1991 i Rule 3.287 NEW YORK STATE DEPARTMENT OF TAXATION AND FINANCE NEW YORK STATE AND LOCAL SALES AND USE TAX FARMER'S EXEMPTION CERTIFtCATE To purchasers and sellers-; To be completed by the termer. given to and retained by the Seller. To have a valid certificate. sit entries inustibe s:ornpiood t- r' Read ell ER st— tIOns carefully IJatoro co- pleling Or aece ping this certificate. 'r To sellers: you may [let accept this certi Ficate as the basis for selling exempt from tax the proper( F y nr services Listed below. Taxmusf,be collei�tei1 o such sales: 7 cerfilioate Illy not be used to claim exemptr'an for the following: a,1a 7' "•�'f1� l 1. utilities, 4ve€ oil, motor fuel or diesel fuel; 2. labor charges in conner-.tion with repair; malmonance of or service to real property; 3. tang ble personal property incorporated into a building. structure. silo foundation. or other capital improvements to real property €excluding grape tee €lisps and the remaining portions of a silb);'4, rngtor vehiclet3,: oF property €ratedl,3s- taxable. Name of seller TRACTOR SUPPLY COMPANY APFI LlATES Attn: Tax Name of Farmer SEE RE VCRSE SIDE Street address 200 Powe P lates Sit~ addle s�I SEE REVERSE SIDE_. II.• r *I City Brentwood Stale TN ZIP Code 37027 City SEE REVERSE SIDE State ZiP COC Check applicable box: ,X] Single Purchase Certificate Blanket CerTiticata I, the reverse signed hereby certify that 1 am exempt from payment of tho sales and use fox on tangible personal property purchased, from you because the property is to be used for art exempt put pose and that certain services are al so exempt where performed on tin exempt property (Check applicable box or boxes.) U (a) Tangible personaf property, except property incorporated into a building or structure, for use or consumption directly arid ciominatelq indthl production of tangible personal property for sale by farming, including stock, dairy, poultry, fruit, fur bearing animal, and truck farmhngl. "t'il'e teen farming also Includes ranching, operating nurseries greenhouses or other similar structures used primarily for the raising of agricultural, horticultural or floricultural commodities, and operating orchards or vineyards. t M (b) Tangible personal property for u n erecting, adding to, altering or improving a silo used in farming to mak® andl'stor�'silage^on a tar provided such tangible personal property is to become an Integral component part of such sit.. (This exemption does not apply to tgnglble persohai property, use_ d In constructing a silo foundation.) f� (c) Posts and wire for use in constructing or maintaining vineyard trellises used in growing grapes for sale. Q (d) Services of installing, repairing, maintaining and servicing exempt tangible personal property. (This exemption is prov(ded for,bmh state and local sales and use tax with the exception of the tax imposed try or for New York City.) Thane statements are made with the knowledge that willfully issuing a false or fraudulent certificate with the Intent to evade t a ax is a. Ynisderearlor urtider lsechon ISI7(m) of the New York State Tax Law atO section 210.45 of the p«nsl law punishable by a fine of not more than u1 ,000, or imprisonment for not more than l a year or'both' Signature of termer or farmers representative (star, title and relationship) SEE REVERSE SIDE t Date Seller The tax exemption for 4armers Es limited to the purchases of (1) tangible potential pro u d perty se .directly and predominantly in the produotion n phase of farming ad (2) the s [vices described in (d) related to that property. F''urchasos for use in administrat€on, storage or marketing or purchases of tangible personal properly used indirectly in farming would not qualify (Soo Publ lost ion'44, Safes Tax Informration for Farmers, for a complete explanation of the tax treatment M farmers purchases and sales.) For your protection, a fanner must ,give you this certificate not later then 90 days after delivery of he properly sold or services renderad. if you have not received this`Ferlifica(e within 90 days of the dale of sale, the sale will be deemed to have been taxable at file time the transaction took piece and the burden of proving it was not, shall be upon both you and the purchaser. purchaser. If the blanket certificate box is checked, you may consider this carte Ficate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives you wri trial notice Of revocation. or until the Tax Department notifies YOU that the pUrcha5er may not Rieke exempt purchases. Purchasar YOU must pay tax on utilities (telephone, telegraph, electricity or gas semico) heatirsg oil, mater fuel and diesel motor fuel at the time of purchase and claim a refund for any exempt use- (tf you a e purchasing diesel motor fuel for exclusive consumption in farm machinery used to producer tangible personal property for sale, you may use Form FT -1004, Fainter, ENO'llotion Certi(rbat. for /P,r,)7aS95 $t Diesel Motor r7ualto purehesa trial fuel exernpl.) if fie blanket certificate box is chocked, you may consider this certificate part of any order received from the purchaser. A blaoxot certificate remains in farce until iho purchaser gives Y." written notice of revocation, or omit me Tax Department notifies you that the purchaser [may not make exempt purchases. REMITTSC BUSINESS ACCOUNT PAYMENTS ONLY TO. TRACTOR SUPPLY COMPANY C�� P.O. Box 689020 Tractor Supply Company a Des Moines, IA 50368 18160 U.S, 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield, IN 46074 (317) 867 -3505 6035 301 NAME CARMEL. STREET DEFT 3400 W 131ST ST ADDRESS WESTF'IELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 786000104 2 998598 02/02/2010 02:16rm CUSTOMER TO COMPLETE 2108927 MALE 3/01/2 HOSE BA 1.00 to 1129 1.29 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned patty certifies their exemption from compliance with the agricultural Subtotal 1.29 payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is 7.00 Tax 0,00 indicated below and understands Total 1.29 engaged in the business of agricultural production of and agrees with the General TSC Card 1.29 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Acct *:#2:##222#2 #:4803 resale and /or uses the farm machinery, equipment or the applicable statement of the other agricultural production items purchased free of Auth #:002650 Refo:0213154607 respective state printed on the tax, as defined b state law, and as indicated below. PO *:shoir reverse side of this form. Y l Chanse 0100 The under art further certifies the Cash Back PRODUCT IS TO BE U SED IN THE FOLLOWING 9 p ar t y Y STATE: understand they may be liable for payment of all taxes Buyer actcnowledses the receipt of a come (R QUIRED) due on the purchase price for the goods as allowed '1' (Exceptions: Georgia, New York Kentucky state law should such goods be used Or consumed In COMPLETE REVERSE SIDE) a taxable manner a s defined b e state laws. copy of this sales slip and the purchase o PURCHASER IS ENGAGED IN: (REQUIRED) f the described merchandise shall be in Resale Under penalty of perjury, signee swears the accordance with the Cardholder Asreement. K Government information on this statement is true and correct in xempt 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: F] Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) 2 #ii #22 /2#2: #:iYYYS2Y2 :3232# ###L Farm Machinery /Repair Parts C N..Government Agency (Entity 2# is## 2 ##2 #2222222S222YiYYYii2322Y2 Livestock Injestibles or Injestibles Exempt Organization (Entity Call 800 0734 within 7 days to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a m drawing for a chance to win a Consumed in Production (KS) E] Resale (Sales Tax Permit $2500 ghopp i n s spree Ingredient or Component Parts (KS) (Awarded as Gift Card) NA PURCHASE OR SURVEY NECESSARY, Ends 9/30/10, Other: iYYYY2Y3Y2s3 #22Y2222YS2### #2 #22i CIASTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.— #ASH CHECK' s -VISA WC DISCOVER TSC CHARGEAGGOUNT NO. CHG EXCH: ©ATE ITEM NUMBER DESCRIPTION V n I Form No. 99-00401 (12/08) CUSTOMER ORIGINAL 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)) 01/29/10 $36.56 02/02/10 $1.29 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 VOUCHER NO. WARR NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $37.85 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 42- 370.00 $36.56 1 hereby certify that the attached invoice(s), or 2201 42- 370.00 $1.29 bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Monday, March 01, 2010 1 VR /i ne J it Street Commissioner Sty' Title Cost distribution ledger classification if claim paid motor vehicle highway fund