156342 02/06/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
it ONE CIVIC SQUARE TRACTOR SUPPLY CO
,a CARMEL, INDIANA 46032 PO BOX 689020 CHECK AMOUNT: $629.16
DES MOINES IA 50368 -9020 CHECK NUMBER: 156342
CHECK DATE: 216/2008
DEPARTMENT ACCOUNT PO NUMBER !NVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 431000807061 31.18 ACCT 6035301200050860
2201 4356001 431000809969 61.57 ACCT 6035301200050860
2201 4232100 431000810326 116.31 ACCT 6035301200050860
2201 4467099 431008103900 388.92 ACCT 6035301200050860
2201 4232100 624000095719 31.18 ACCT 6035301200050860
page 1 of 4 Tx 7 DI1i4Oft
T
SUPKYCO-
BUSINESS ACCOUNT
�A
0000332
ME
gACGOUNT SU;MMARI(� 6035 3012.0005fifi0
Previous Balance 1,967.03 Closing Date 01/21 /08
Payments 749.21 Next Closing Date 02/19/08 CARMEL STREET DEPT
Credits 0.00 Payment Due Date 02/15/08 CINDY
Purchases 629.16 3400 W 131 ST ST
Debits 0.00 Current Due 629.16 WESTFIELD, IN 46074 8267
FINANCE CHARGES 0.00 Past Due Amount 1,217.82 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 1,846,98 Credit Available 3,403
New Balance 1,846.98
CURRENT ACTIVITY
1
Transaction Locatlanl Amount
Date Descnpt!on
i.,�F
DEC 27 GOODS AND SERVICES WESTFIELD IN 31.18
JAN 1D GOODS AND SERVICES WESTFIELD IN 116.31
JAN 10 GOODS AND SERVICES WESTFIELD IN 388.92
TOTAL 6035301200074803 $536.41
JAN 14 GOODS AND SERVICES NOBLESVILLE IN 31.18
TOTAL 6035301202895866 $31.18
JAN 8 GOODS AND SERVICES WESTFIELD IN 61.57
TOTAL 6035301202896039 $61.57
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 33 0.00 13.01 00000 30 a.0o
K A.�
This Account Issued by Citibank
q s wr ,rr,�_,_ Ley „.flVkCE 1 -800- 559 -8232 FAX NUMBER 1- 801 779 -7425 ,L
Notify Us in Case of Errors or Ouestions About Your Bill Copy Fee: On any matter unrelated to a billing error or disputed purchase,
we charge a $5.00 fee for each duplicate statement for a billing period that
If you think your billing statement is wrong, or if you need more information is more than 3 months prior to your request. We add this fee to your regular
about a transaction on your billing statement, write to us (on a separate revolve credit plan balance.
sheet) as soon as possible at the billing error address on the front of your
statement. We must hear from you in writing no later than 60 days after we Payment Options Other Than Regular Mail:
sent you the first statement on which the error or problem appeared. In your
letter, give us the following information: Pay by Phone. You may make your payment by phone by using the Pay by
Phone Service. You will be charged $14.95 to use this payment service.
Your name and account number. Call by 5 p.m. Eastern time to have your payment credited as of that day.
The dollar amount of the suspected error. If you call after that time, your payment will be credited as of the next day.
Describe the error and explain, if you can, why you believe there is an We may process your payment electronically upon verification of your
error. If you need more information, describe the item you are unsure identity.
about. Send payment by courier or express mail to the Express Payments
address: Customer Service Center, Dept. CCS 8725 W. Sahara Blvd., Las
Important Payment Instructions Vegas, NV 89117. Payment must be received in proper form, at the proper
address, by 5 p.m. Pacific time in order to be credited as of that day. All
Crediting Payments: Payment must be received in proper form at our payments received in proper form, at the proper address, after that time
processing facility by 5 p.m. local time there to be credited as of that day. A will be credited as of the next day.
payment received at the processing facility in proper form after that time will
be credited as of the next day. Please allow 5-7 days for payments by Report a Lost or Stolen Card Immediately: Customer Service is available
regular mail to reach us. There may be a delay of up to 5 days in crediting a 24 hours a day, 7 days a week.
payment sent by mail if it is not in proper form or is addressed to a location
other than the address listed on the return envelope or on the front of the Your account is issued by Citibank (South Dakota), N.A.
payment coupon, or, for courier or express mail payments, to the Express
Payments Address set forth below.
Proper form: For a payment sent by mail or courier to be in proper form,
you must:
Enclose a valid check or money order. No cash, gift cards, or foreign
currency please.
Include your name and account number on the front of your check or
money order.
Tractor Supply Co. Full Bal S902TV 10/06
902TV Y
page 2 of 4 TX 7 DI 0
SUMYC°
BUSINESS ACCOUNT
0000333
�p
CURRENT ACTIVITY
2 Ctlgll I OC2tIOfU a
b$t0Q$f f1�1110f1 x ...a
/4
Ft10[It
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
DEC 20 PAYMENT REF P919400B209JW2HVB 749.21
Customer Service and Billing Errors address: PO Box 689161, Des Moines,
IA 50368 -9161.
CARD AGREEMENT INFORMATION UPDATE.
PLEASE KEEP THIS NOTICE.
We are adding an optional Pay by Phone Service. This service is
disclosed in the following new section which we
are adding to your Card Agreement:
"Optional Pay by Phone Service. You may request to make your payment by
phone using our optional Pay by Phone Service. Each time you make such a
request, you agree to pay us the amount shown in the Pay by Phone
section on the back of the billing statement. Our representatives are
trained to tell you this amount if you decide to use this optional Pay
by Phone Service."
Did you overlook your payment to us? If
so, please send the amount due today. If
payment is in the mail thank you!
190
Remit To: Bill To: Page a or 4
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860
7su"Lyco. DEPT.30- 1200050860 JEFF STEWART
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000334
r..
Payment Due Date: 02/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
sntP To: INVOICE: SHIP TG: INVOICE:
624000887784010 431000802226010
Purchase Order: Purchase Order:
WINTERBOOTS TRUCK57
AMOUNT DUE: 129.95 AMOUNT DUE: 379.97
Store: 574000624 INVOICE DATE: 12110 /07 Store: 574000431 INVOICE DATE: 12/11 107
BOOT 13M GTX OS WEL TAN 1424873 1.00 129.95 129.95 POST HL 010 POWER GAS 2118956 1.00 219.99 219.99
3 YEAR SERVILE PLAN 8700028 1.00 34.99 34.99
SUBTOTAL 129.95 POST HL DIG AUGER 6 GA 2119326 1.00 124.99 124.99
TAX 0.00
SHIPPING 0.00 SUBTOTAL 379.97
TAX 0.00
TOTAL 129.95 SHIPPING 0.00
TOTAL 379.97
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000807061010 431000810390010
Purchase Order: Purchase Order:
SHOP TRUCK2
AMOUNT DUE: 31.18 AMOUNT DUE: 388.92
Store: 574000431 INVOICE DATE: 12127 107 Store: 574000431 INVOICE DATE: 01/10 108
LIGHT TRAPEZOID 496 HAL 0283917 1.00 15.59 15.59 BED MAT OFT FORD 250 35 0184901 1.00 59.48 59.48
FLOOD LIGHT 4X6 HALOGEN 0283909 1.00 15.59 15.59 TRKBX ALUM SGL FS DEEP 1091703 1.00 329.44 329.44
SUBTOTAL 31.18 SUBTOTAL 388.92
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 31.18 TOTAL 388.92
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
191
Remit To: Bill To: page 4 or 4
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TO§
DEPT.30 1200050860 JEFF STEWART 10SUMUO
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000355
r
Payment Due Date: 02115/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000810326010 624000905719010
Purchase Order: Purchase Order:
SHOP SALTTRUCKS
AMOUNT DUE: 116.31 AMOUNT DUE: 31.18
Stare: 574000431 INVOICE DATE: 01/10/08 Store: 574000624 INVOICE DATE: 01/14 108
LIGHT TRAPEZOID 4K6 HAL 0283917 1.00 15.59 15.59 LIGHT TRAPEZOID 4X6 HAL 0283917 1.00 15.59 15.59
CASTER BIN HD TPR SWIVE 5500461 1100 25.68 25.68 LIGHT TRAPEZOID 06 HAL 0263917 1.00 15.59 15.59
CASTER BIN HD TPR RGD 5500479 1.00 24.68 24.60
CASTER BIN HD TPR SWIVE 5500461 1.00 25.68 25.68 SUBTOTAL 31.18
CASTER BIN HD TPR RGO 5500479 1.00 24.68 24.66 TAX 0.00
SHIPPING 0.00
SUBTOTAL 116.31
TAX 0.00 TOTAL 31.18
SHIPPING 0.00
TOTAL 116.31
SHIP TO: INVOICE:
431000809969010
Purchase Order:
10808
AMOUNT DUE: 61.57
Store: 574000431 INVOICE DATE: 01108 108
QUILT NEST BLK 2K 6420690 1.00 61.57 61.57
SUBTOTAL 61.57
TAX 0.00
SHIPPING 0.00
TOTAL 61.57
Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425
REMITTSC BUSINESS ACCOUNT
�VT RACTOR
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
��y C® P.O. Box 9020
Tr, ici ro I Curl' r
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 1.k21J, it
6035 301#
NAME
Pl
J U 1 31
ADDRESS 1.311 :El-1?
CITY STATE ZIP PHONE
131 Z 80 ,16 i
CUSTOMER TO COMPLETE LI GH l;,• ")Fc1, -b).J> 4X6
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. 1 't'1, L t
The undersigned certifies The undersigned party certifies their exemption from o:?s Po (i mjj 1.1(3i;! '4;` :)('lG
compliance with the agricultural payment of sales and use tax on tangible personal i 3° n C l f' r;
sales tax exemption law of the state g p
indicated .below and understands property as indicated below and /or purchaser is Uuvc:.•ut.,r�u r
and agrees with the General engaged in the business of agricultural production of
Exemption Statement a right and food or fiber, horticulture, aquaculture of floriculture for ;uL k ui o s i l i"
the applicable statement of the resale and /or uses the farm machinery, equipment or 6.601% Tau 01010
respective state tome on the other agricultural production items purchased free of (ui�ai sl .t
reverse side of this form. tax, as defined by state law, and as indicated below. TSC Co cl
:8 ?F "3$:3 ';i'110
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they iulth::0
STATE: understand they may be liable for payment of all taxes Pa v: sltol'
(REQUIRED) due on the purchase price for the goods as allowed by Cn-'n�je
(Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in C15). &x:,
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED) iL1YLi .•r lu:a,!It'd it,'� I'ct �1,' i u, CUntl`Lt'
Resale Under penalty of perjury, signee swears the? i
Government information on this statement is true and correct in C01 Y OT tit, ,r' oild ih' vurch:,;o u
Exempt organization every material manner. A willfully false representatioh
Agricultural Production of exemption will cause the purchaser to be subject to JQ'..SLrJilt -d
Dairy Production
Livestock Production �1t,Cf'i ti l! t h penalty and /or other provisions as allowed under state O vu Car diw ld "t' tiJl'E`Et:•Pli i
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt
Resale (Sales Tax Permit 3 o it 8 C'3 a i z J
Consumed in Production (KS) Cell 05il 9� 73't u ••thin 7 ci,: vt3 rD
Ingredient or Component Parts (KS) _uldPl n �tu'l'e „ud 11._ Cit !.'t
Other: •4 III i J• ovil tt roi I Ent'1!' N i;J a e
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C ATURE: (R ]RED) MGR. APPROVAL
X
USE SHAIDIEID AREA ONLY
906H HECK VISA M/0 DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
TAX Form No. 99-00401 (12/05) CUSTOMER ORIGINAL
RE�11iITTSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUPPLY C9 P.O. Box 9020
Des Moines, IA 50368 -9020 i 1' T culu.ct`3.
TSC TEAM MEMBER TO COMPLETE please include 16 Digit Account Number ttL's ct ill
6035 301 317)
NAME
L' Rh l- STREU I)EPT
J0 41 131' r 9 -i
ADDRESS Ul"SIFIE U P ei 60 7 �'UZ6(
(.S1O 21 -'H
CITY. STATE ZIP PHONE
-z3I 6230 ";'v13;� E31412
C)111011Z.V10 0.7 e:
CUSTOMER TO COMPLETE 02;3V1 r 1-10H11 TRAPEZU10 4X6
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- •G t.' I';.`..;s
tiL4'[C9i[?'.Enf
The undersigned certifies The undersigned party certifies their exemption from 55l?U'i A CrICTE" hail tau 'fl- Z t' l
compliance with the agricultural 1 100 C 2`3.60 25. OR NT
sales tax exemption law of the state payment of sales and use tax on tangible personal
indicated below and understands property as indicated below and /or purchaser is C}��,.•�1ij�E'�1tnt1-'I 1. P' 3 .`LlC,4
e ngaged in the business of agricultural production of Gr, Ft" .r ,,a WI\ t'o
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for i L 2 60 2� r E ;11
Exemption Statement at right and resale and /or uses the farm machinery, equipment or 6 1'111 "zn t kzwnt.iE,
the applicable statement of the other agricultural production items purchased free of 5:3Ci:'161 CA'5TC R 0114 tt)) 'f R ail
respective state printed on the t C1'7 H 25.66 `i5 60 iff
reverse side of this form. tax, as defined by state law, and as indicated below.
.�UIE:.riTrlt' ?kQ F.�fE: Cle:
PRODUCT IS TO RE USED IN THE FOLLOWING The undersigned party further certifies they W5t)34 e C67LI: OI:' HD
STATE, understand they may be liable for payment of all taxes I G tt i 6U
(REQUIRED) due on the purchase price for the goods as allowed by Covet' oloep t.- Ai tiv])Liet1
(Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in
COMPLETE REVERSE SIDE) c tIb tl1 r r 1 r• J k
a taxable manner as defined by state laws. 6 bI, tari G. 00 PURCHASER IS ENGAGED IN: (REQUIRED)
[:1 Resale Under penalty of perjury, signee swears the )viol 1'1 ti'i
Government information on this statement is true and correct in i';t: C, 1 1 u. S1
Exempt organization every material manner. A willfully false representation (il c t t g 4Cn3
E] Agricultural Production of exemption will cause the purchaser to be subject to l'' i, I 0 X101) t .:10u''22w 1C
Dairy Production P11 }MP
Livestock Production penalty and/or other provisions as allowed under state
i'i L
law. 1 0. ')U
Floriculture /Aquaculture Production G.::• k',ic1.
Other:
Iri•,YII{' i:r.I.i: ZL':,'_ tht i ecei' i Of i2 cuoil).i
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
r ci
Farm Machinery/Repair Parts Government Agency (Entity C QI' Of i l t i b u 1 r' l i T end t l l4 P LW IZ I I:? ie Q
Livestock Injestibies or Injectibles Exempt Organization (Entity i
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt i>I^ .r -tom _C s6 a ;,L c1t,; i!Lfi sha be in
.iCe 111 L }1 arP dh�lct;:l P, r; °;:ors
F1 Consumed in Production (KS) Resale (Sales Tax Permit "he t
Ingredient or Component Parts (KS)
Other:
rtd) u;. ,•.a..lU).. 1t� ttt"! Y iT,� �37I,
J.. 1111.. »_1111...--
CUSTO R S TUR :`(REQUIRED I r MGR. APPROVAL
X
USE §HA WHEN EGISTER IS INOPERATIVE.'
CHECK VISA M /C' DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH.' DATE
'Esi
-,.0
n: T.:
.v o.,
f;�i! *.Z.t•�:g'Sk k..`,,:;c.rti+.,;i3t_.;;y 1111
Form No. 99-00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
"gepnyQ P.O. Box 9020
Des Moines, IA 50368-9020 1J. 31 81
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
NAME
ADDRESS
CITY
CUSTOMER TO COMPLETE
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: �'6.96
The undersigned certifies The undersigned party certifies their exemption from
compliance with the. agricultural payment of sales and use tax on tangible. perso* nal
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 6, T,t x 0,
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Tu t a t 61 V
Exemption Statement at right and resale and/or uses the farm machinery, equipment or TS". C,.-,,-j 61 1�/
the applicable statement of the other agricultural production items purchased free of I'l cc i: ii! I
respective state printed on the tax, as defined by state law, and as indicated below. f 013 132 e3
reverse side of this form. 111
PRODUCTISTO BE INTHE FOLLOWING The undersigned party further certifies they Charl�ie rd Oct
STATE: understand they may be liable for payment of all taxes
(REQUIRED) due on the purchase price for the goods as allowed by
(Exceplions: Georgia, New York Kentucky state law should such goods be used or consumed in
c
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. it
F Resale Under penalty of perjury, signee swears the'
Government information on this statement is true and correct in
Exempt organization every material manner. A willfully false representation
5 Agricultural Production of exemption will cause the purchaser to be subject to
F Dairy Production penalty and/or other provisions as allowed under state
F Livestock Production
[J Flo riculture/Aquacu Itu re Production law.
F1 Otlher�
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
F Farm Machin Parts Government Agency (Entity
EJ Livestock Injestibles or Injectibles E] Exempt Organization (Entity.4 t.! 33,
Fertilizer/Agrichemicals NC: only DOT and US Government are exempt 800-968-0 oith-'ii Y to
Consumed in Production (KS) El Resale �Sales Tax Permit CUIIF�i-.-ia ti oid 'Le eiitei-ed in
C3 Ingredient or Component Parts (KS) shapt Lw� 5r
7 Other: (Aictrded as Gift C,- P40 lott,7CHASE
CUSTOMER SIGNA' fREQU[RED) 1C MGR. APPROVAL
CASH CHECK A DISCOVER TSO CHARGE ACCOUNT.NO. DATE
WC
HG. EXCH.
LJ
�orm No. 99-00401 (12105) CUSTOMER ORIGINAL
NUM
B R7
JTEM
REMff TSC BUSINESS ACCOUNT
PAYM TO
TRACTOR SUPPLY COMPANY
1 i a.
C O P.O. Box 9020 7. ..c
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301
NAME
3 :d
ADDRESS
CITY STATE ZIP PHONE
'S 1 •tat ;lC�)t �0 :11 U'�:`G
it/ io/MS 02 :0Ceta
CUSTOMER TO COMPLETE 0 1t;:,9 0 1 yLD t)r; 8FT FNr_� 2
i.00 L1 r ;9. "W. tU r
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies The undersigned party certifies their exemption from I0917 TRIM F:E_Uit 5Ci_ I "3 t/L
compliance with. the agricultural payment of sales and use tax on tangible personal 1,00 L '.0 4 A '2 .44 ii
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
and agrees with the General 1 b I. ill 3
Exemption Statement at right and
food or fiber, horticulture, aquaculture of floriculture for
04a
r
the applicable statement of the t'ufiai 0 Uri
resale and /or uses the farm machinery, equipment or 3£'.. Q
;r
respective state printed on the other agricultural production items purchased free of 'r. I f) 3 1, 9'1
reverse side of this form. tax, as defined by state law, and as indicated below. tt.:c i t Us
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they
understand the may be liable for p ayment of all taxes C "J t r uc.s
STATE: Y Y p Y i.l3:�i'J%' Q,0)
(REQUIRED) due on the purchase price for the goods as allowed by f t. s•
(Exceptions: Georgia, New York R Kentucky state law should such oods be used or consumed in
COMPLETE REVERSE SIDE) g
a taxable manner as defined by state laws. u
PURCHASER IS ENGAGED IN: (REQUIRED) ,(I d
Resale Under penalty of perjury, signee swears the C It r U; 'th i,y .,al I r a Iu t I rcia.
F 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 i Cep 'Jhw' C;L.I
El
Livestock Production penalty and /or other provisions as allowed under state
(Floriculture /Aquaculture Production taw'
Other: tii,'rldiurc
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity f s
Fertilizer /A nchemicals NC: only DOT and US Government are exempt
Consumed in Production KS Resale (Sales Tax Permit 1 C it,)
onsue oucon i r t� t 7
Ingredient or Component Parts (KS) �tr le f! a our vc a.od i �2n td; ri :a
'to
F Other:
G.'; Cotr;) #std
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
X
o INO
CASH CHECK VISA 1,: M /C DISCOVER. TSC CHARGE ACCOUNT NO_` CHG., DATE
Li
J PRICE
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
10 T PAYMENTS TO:
TRACTOR SUPPLY COMPANY
Su Y C0 P.O. Box 9020 T,', +et�r Skwv)y C� -eAiiy
Des Moines, IA 50368 -9020 S E<, -nf r' ±.tcronri '3'i
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number "6Q t 31'I�'. l )if.t
7r� t63s
6035 301
NAME tPR11LL �iTF;EFr F.('T
3400 ".f 33 i Sl' ST
ADDRESS t:5t7) 5rt��l�rt
CITY STATE I ZIP PHONE 624 624006081 2 V05? 1 9
CUSTOMER TO COMPLETE oft).;�1 T Irtfr 1j'ii z�115 ,a,
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Grivoi,
The undersigned certifies L'u"irr rP FPI—i rD
The undersigned party certifies their exemption from 02113ti 1 00 f, I S 5g
compliance with the agricultural payment of sales and use tax on tangible personal
sales tax exemption law of the state
indicated below and understands Property as indicated below and /or purchaser is
and agrees with the General engaged in the business of agricultural production of Cttbto10,1 3i itt
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for 6.0% T4A 0"00
the applicable statement' of the resale and /or uses the farm machinery, equipment or Tato 3t 1t1
respective state printed on the other agricultural production items purchased free of T' C r d 31 j L'
reverse side of this form. tax, as defined by state law, and as indicated below. r;c( 8 d $,,`4
The Au t i0 01,504 reef 14134,PP 34G
e under PRODUCT IS TO BE USED IN THE FOLLOWING g party further certifies they PU
STATE: understand they may be liable for payment of all taxes (ha rl g;, 0 00
(REQUIRED) due on the purchase price for the goods as allowed by 0317 B:.;_Ic
(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. Dt,r .cjc tawleu rs Me et_ceie r o-t o L,AmF' "t.F
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the t.0r"i of iIIis 3icl1.r.; a7.iI' �Jltt1 '(1. ettl't_i1t:.',r U
Government information on this statement is true and correct in
Exempt organization every material manner. Awillfully false representation i) �;c �,_t'ibc =tJ .net'ctl trit isr: Shalt Le in
Agricultural Production of exemption will cause the purchaser to be subject to c;at W. t;, Eh,,: C:', ,;i, t.'.r• I t
7 Dairy Production penalty and /or other provisions as allowed under state
Livestock Production
Floriculture /Aquacullure Production IoW'
Other: r i i-sm tt(i e t
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
FertilizerlA NC: only DOT and US Government are exempt y
E] 9 ni chemicals 88` ?:'P,ts£<,�,
Consumed in Production (KS)
Resale (Sales Tax Permit Le l f9 0- e i.3 f d':r i tJ
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Ingredient or Component Pacts (KS) dt' ao u v
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Other:
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CUSTO ER IGNATUR REQUIRED) MGR. APPROVAL
X
USE SHADEb'AREA ONLY
CASH CHIEUKV VISA M /C, DISCOVER TSC CHARGE ACCOUNT NO. CHG, EXCH. DATE:
ITEM NUMBER RIP b UNIT PRICE
Form No. e9-00401 (12/05) CUSTOMER ORIGINAL
Prescribed by Stale 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
(A Clio( �l Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6
6 o 35 Board Members
flew INVOICE= NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
q3100041 0 to 10 E c bill(s) is (are) true and correct and that the
I j 0- .Vi orl D 00. Q x+38, 4 materials or services itemized thereon for
1 0 �,Rtnol 3 a. I i 1 b 3 1 which charge is made were ordered and
received except
J 20
7 Signat6r
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund