167006 12/17/2008 CITY OF CARMEL, INDIANA VENDOR: 354290 Page 1 of 1
ONE CIVIC SQUARE BOONE COUNTY AUTOMOTIVE, INC CHECK AMOUNT: $36.52
CARMEL, INDIANA 46032 1212 W MAIN ST
LEBANON IN 46052 -2324 CHECK NUMBER: 167006
CHECK DATE: 12/17/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
911 4351000 7983 7.89 716635
911 4351000 7983 28.63 716647
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t t r NAPA Auto Parts of Carmel
111 Medical Drive Carmel, Indiana 46032 317 844 -3973 Fax: 317 844 -6220
Please Remit To: H H Automotive Supply 1212 W. Main St. Lebanon, IN 46052 agricultural use
AGRICULTURAL EXEMPTION CERTIFICATE T
A INDIANA DEPARTMENT OF REVENUE SALES TAX DIVISION
LIMITED WARRANTY PLEASE READ
1 hereby certify under the penalties of perjury that the personal property purchased by the use of this exemption certificate will be
directly used in the direct production of agricultural products for resale.
Please examine these parts at once. Errors should be reported before using or installing. Returns 'The factory warranty constitutes all of the warranties with respect to the sale of this itemh The seller hereby expressly r
C must be made within TEN DAYS and must be accompanied by this INVOICE NUMBER. This disclaims all warranties, either express or implied, including any implied warranty of merchantability or fitness for a particular
property is sold to you with the definite understanding that it is purchased for resale, unless tax purpose and the seller neither assumes nor authorizes any other person to assume for it any liability in connection with the
has been added to the price. ALL RETURNS SUBJECT TO 10% RESTOCKING CHARGE. sale of this itenl(tems.
NO RETURN ON ELECTRICAL PARTS.
ACCT SOLD TO DATE TIME STORE EMP
1 7`:�8,?, (_::1 "`l. �1= C�tf t�!( L.,'Fl ?I__SC;t: D�: �1° r�) iiES 3n'�f� 1t'at'at ?t: ?C,1 r 1C.,E
SR 3 CIVIC SQUARE PURCHASE ORDER ATTENTION
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4.60 3.2 TAX EXEMPTION:
AD EEP COPY II` V TERMS ,I�� dil..ie 10th rHAFt[-3E S-nI -E
9 DELIVERY: UR TFZUCV
PART NUMBER LN DESCRIPTION QUANTITY PRICE NET TOTAL
60-24() W 1 P "I_EF"I-J311 WIPER NLA!: >E 1. 00 32:. 530 1(S. 77 0 1 ItS. 77
C- 10--1940 W I: TE:".FI -ON WIPER L?i._A10E 1 W 100 090 11. 860 11,. 86
REMIT TO: 12 (27' W MAI Teat 7% TAX T ABLE 3 0 C)0
SIGNATURE TOTAL CHARGE �Fll..�E1a
ALL GOODS TURNED MUST BE ACCOMPANIED BY THIS INVOICE
VOU -HER NO._, WARRANT NO.
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ALLOWED 20
IN SUM OF
j G�► c rJ S d,
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ON ACCOUNT OF APPROPRIATION FOR
Board Members i
PO# or DEPT. INVOICE NO. ACT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
g i 1 1(663S S/0-- 7 d4 bill(s) is (are) true and correct and that the
9/ t G y7 ti3 materials or services itemized thereon for
which charge is made were ordered and
received except
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Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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