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Home My WebLink About163429 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO CARMEL, INDIANA 46032 PO BOX 689020 CHECK AMOUNT: $139.88 DES MOINES IA 50368 -9020 CHECK NUMBER: 163429 CHECK DATE: 9/3/2008 DE PARTMENT ACCOUNT P O NUMBER INVOIC NUMBER AMOUNT DESCRIPTION 2201 4237000 STREET 139.88 6035301200050860 f page t of 5 TX 7 D11300 'y =o C B iyY�/i�ii/i8 V8i� 7SU i MYC BUSINESS ACCOUNT 0000489 Al 6 CCQU Ts�I I ARY 3Q�1 4$ Q Previous Balance 1,301.13 Closing Date 08/19/08 Payments 0.00 Next Closing Date 09/18/08 CARMEL STREET DEPT Credits 0.00 Payment Due Date 09/13/08 CINDY Purchases 139.88 3400 W 131ST ST Debits 0.00 Current Due 139.88 WESTFIELD, IN 46074.8267 FINANCE CHARGES 0.00 Past Due Amount 1,301.13 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 1,441.01 Credit Available 3,808 New Balance 1,441.01 CURRENT ACTIVITY TrBCtan r s LOCati41U x A01t(t��' SCr�R #Ort w AUG 5 GOODS AND SERVICES WESTFIELD IN 12.44 TOTAL 6035301200074803 $12.44 JUL 31 GOODS AND SERVICES WESTFIELD IN 39.99 AUG 6 GOODS AND SERVICES NOBLESVILLE IN 44.98 TOTAL 6035301202895866 $84.97 JUL 23 GOODS AND SERVICES WESTFIELD IN 7.08 JUL 30 GOODS AND SERVICES WESTFIELD IN 2.58 TOTAL 6035301202895882 $9.66 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Billirg PERCENTAGE Subject to Periodc Bllirg PERCENTAGE Finance Charge Rate Penod RATE Finance Charge Rate Pericd RATE REGULAR REVOLVE CREDIT PLAN 0.00 00000 29 0.00 0.00 .00000 sa 0.00 This Account Issued by Citibank (South Dakota). N.A. CUSTOMER SERVICE 1-800-559-8232 FAX NUMBER 1- 801 779 -7425 Information About Your Account applicable daily periodic rate, and add those t +.vo figures together, the result is the periodic finance charges assessed for that balance, except for minor variations Grace Period for Purchases: The grace period for purchases is at least 20 days. caused by rounding. Therefore, to avoid periodic finance charges on purchases that appear on this If a periodic rate is a monthly periodic rate, we use the following calculation t' statement, you must (1) ;rave paid the New Balance, plus the nilnimum monthly method. We take the beginning balance for each balance every day (including payments required for your No Interest and 0% balances, on the last statement by that periodic finance charges Imposed in previous billing periods) add any new statement's payment due date and (2) pay the New Balance, plus the rninimum monthly charges, subtract any credits or payments credited as of that day, and make other payments required for your No Interest and 0 °o balances, on this statement by this adjustments. A credit balance is treated as a balance of zero. This gives Us the statement's payment due date; but i3) you may take advantage of the fulfo�,ving daily balance. We add up all the daily balances for the billing period (including the exceptions (the "Promotional Balance Exceptions for No Interest or 0% balances: balances on the Closing Date) and divide by the total number of days in the billing First, you can subt.aci from the New Balance any No Interest or 0% balances that period. This gives us the Balance Subject to Finance Chaigc for that balance. We do not expire by the Next Closing Data shown on the statement, figure the periodic finance charge by multiplying the Balance Subject to Finance Second, you can pay any No Interest or 0% balances that do expire by the Next Charge for that balance by the applicable rnonthly periodic rate. In addition, for Closing Date shown on the statement on the later of the promotion's expiration date each purchase balance, we multiply the Balance Subject to Finance Charge for or the statement's payment due date, that balance for the previous billing period by the applicable: monthly periodic rate, unless your account was credited for the full New Balance, plus the rninirnum Balance Subject to finance Charqe: We calculate periodic finance charges separately monthly payments required for your No tnterest and 0% balances, an your for each balance subject to different terms (e.g. purchases made pursuant to previous billing statement by that statement's payment due date (subject to the promotional offers and regular revolve credit plan purchases). Charges include Promotional Balance Exceptions described above in the Grace Period for purchases, fees, and any minimum finance charge. Purchases) or a per finance charge was already billed on that balance. Two -cycle Average gaily Balance (Including New Transactions): If a periodic rate is a daily periodic rate, we use the following calcuiaiion method. Notify Us in Case of Errors or Questions About Your Bill For each balance, we multiply the daily balance by the applicable daily periodic rate. We do this for each day in the billing period, including the Closing Date. In If you think your billing statement is wrong, or if you need more information about a addition, for each purchase balance, we multiply the daily balance for each day of transaction on your billing statement, write to us (on a separate sheet) as soon as the previous billing period by the applicable daily periodic rate, unless your possible at the billing error address on the front of your statement. We most hear from account was credited for the full New Balance, plus the minimum monthly you in writing no later than 60 days after we sent you tf,e firs`: statement on which the payments reouired for your No Interest and 0% balances, on your previous billing error or prolulem appear ed. statement by that ,latcm(art's aayurent due elate ;subject to the Prornotionai Bzd mce Exceptions described above ir. tn, Grace Period for Purchases) or a In your letter, give us the following information: periodic tinance ,..harge. %vas already billed on that balance. To get the daily Your name and account number. balance, we take the begiuni,nq balance for each balance every day, add any new The dollar amount of the suspected error. charges and any periodic finance charge on the previous day's balance, subtract Describe the error and explain, if you can, why you believe there is an error. If you any credits or payments credited as of that day, and make other adjustments. A need more information, describe the item you are unsure about. credit balance is treated as a balance of zero. For each balance, the Balance Subject to Finance Charge is the average of the daily balances during the applicable billing period. For each purchase valance, if you multiply the current billing period Balance Subject to Finance Charqe by the number of days in the billing period and uy the applicable daily periodic rate, and you multiply the Previous billing period Balance Subject to finance Charge (if currently subject to a finance charge) by the number of days in that billing period and by the Important Payment instructions Payment Options Other Than Regular Mail: Crediting Payments: Payment must be received in proper form at our processing Pay by Phone. You may make your payment by phone by usinq the Pay by Phone facility by 5 p.m. local time there to be credited as of that day. A payment received at Service. You wiil be charged $14.9', to use this payment service. Call by 5 p.m. the processing facility In proper form after that time will be credited as of the next day. Eastern tlrne to have YOU1 payment credited as of that day. if you call after that Please allow 5-7 days !or payments by regular mail to reach us. There inay be a delay time, your payment will be credited as of the next day. We may process your of up to 5 days in crediting a payment sent by mail if it is not in proper form or is payment electronically upon verification of your identity addressed to, a location other than the address listed on the return envelope or on the Send payment by courief or express mail to the Express Payments address: front of the payment coupon, or, for courier or express mail payments, to the Express Customer Service Center, Dept. CCS 922, 4740121st Street, Urbandale, IA 50323. Payments Address set forth below, Payment must be received in proper form, at the proper address, by 5 p.m. Central time in order to be credited as of that day. All payments received in proper form, at Proper Form: For a payment sent by mail or courier to be in proper form, you must: the proper address, after that time will be credited as of the next day. Enclose a valid check or money order, No cash, gift cards, or foreign currency pfease. Report a Lost or Stolen Card Immediately: CustohT ci Servlce is available 24 a Include your narne and account ^umber on the front of your check or money order. d. €y, 7 clays a weep. Copy Fee: On any matter unrelated t a t,illinq error or r_iisputed purchase, we charge a 55.00 fee for each cups cate statement for a billing period that is mote than 3 months prior Cn your request. We. add this fee to your regalaf revolve credit plan balance. Tractor Supply CRC S602TV Rev. 10/05 602TV571006 PCT page 2 of 5 Tx 7 D1130000000 1� IV T 8 O ppR0 BUSINESS AC —moo 0000490 CURRENT ACTIVITY Tr n a k �m nt L Q AUG 15 GOODS AND SERVICES WESTFIELD IN 32.81 TOTAL 6035301202896120 $32.81 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! Remit To: Bill To: Page 4 or s 284 TRACTOR SUPPLY-CREDIT PLAN ACCOUNT: 6035301200050860 TWTOR DEPT.30 1200050860 STEVE JONES �Su"LYCo PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000492 Payment Due Date: 09/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP T0: INVOICE: SHIP To: INVOICE: 624001003442010 431000860074010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 44.98 AMOUNT DUE: 7.08 Store: 574000624 INVOICE DATE: 08/06 /08 Stare: 57400043/ INVOICE DATE: 07/23 /08 DISCONNECT 181N WANDQUI 3807168 1.00 25.99 23.99 LOCK PIN PTO 4 HUSKEE L 1830220 1.00 2.29 2.29 BAND SAW BLADE 3/4X93%. 3813127 1.00 20.99 20.99 HITCH PIN 1 /2X4IN SAFE 0267822 1.00 4.79 4.79 SUBTOTAL 44.98 SUBTOTAL 7.08 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0100 TOTAL 44.98 TOTAL 7.08 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000861832010 431000854666010 Purchase Order: Purchase Order: 7302008 70308 AMOUNT DUE: 2.58 AMOUNT DUE: 47.12 Store: 574000431 INVOICE DATE: 07/30 /08 Store: 574000431 INVOICE DATE: 07103 108 PVC ELBOW STREET 90 3/4 3181075 1.00 1.29 1.29 TOP LINK BUSHING CAT 1 0268446 1.00 1.79 1.79 PVC ELBOW STREET 90 3/4 3181075 1.00 1.29 1.29 CAT BUSHING 3 -2 3PT TOP 0267945 1.00 1.99 1.99 CAT BUSHING 3-2 3PT TOP 0267945 1.00 1.99 1.99 SUBTOTAL 2.58 TOP LINK BUSHING CAT 1 0268446 1100 1.79 1179 TAX 0.00 TOP LINK BUSHING CAT 1 0268446 1100 1.79 1.79 SHIPPING 0.00 TOP LINK BUSHING CAT 1 0268446 1100 1.79 1.79 HANGER W 9IN BOLT 3551848 1.00 35.98 35.98 TOTAL 2.58 SUBTOTAL 47.12 TAX 0.00 �Ir C) SHIPPING 0.00 TOTAL 47.12 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425 I i 2R5 Remit To: Bill To: page 5 of 5 TRACTOR SUPPLY'CREDIT PLAN ACCOUNT: 6035301200050860 TRACTOR DEPT.30- 1200050860 MIKE HENRICKS 10SUPWCO2 PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000493 Payment Due Date: 09/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000858012010 431000865760010 Purchase Order: Purchase Order: 71508 81508 AMOUNT DUE: 19.99 AMOUNT DUE: 32.81 Store; 574000431 INVOICE DATE: 07/15 /08 Store: 574000431 INVOICE DATE: 08/15 /08 HAIRPIN COTTER KT 1833448 1.00 19.99 19.99 G8 GALV AND COTTERPIN B 3568887 9 -40 3.49 32.81 SUBTOTAL 19.99 SUBTOTAL 32.81 TAN 0.00 TAR 0.00 SHIPPING 0.00 SNIPPING 0.00 TOTAL 19.99 TOTAL 32.81 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 Remit To: Bill To: Page 3 or s 283 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860�R� DEPT.30 1200050860 JEFF STEWART VSUMYC� PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000491 Payment Due Date: 09/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN s e SHIP TO: INVOICE: SHIP TO: INVOICE: 431000855620010 431000857557010 Purchase Order: Purchase Order: SHOP 71408 AMOUNT DUE: 117.46 AMOUNT DUE: 160.90 Store: 574000431 INVOICE DATE: 07/07 /08 Store: 574000431 INVOICE DATE: 07/14 /08 BINDER CHAIN G70 YC 3/8 3543829 1.00 65.47 65.47 LACQUER THINNER GA 3441069 1.00 13.99 13.99 LIGHTS TOWING MAGNETIC 1069332 1.00 51.99 51.99 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 SUBTOTAL 117.46 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 TAX 0.00 PAINT T8T GAL GY PRIMER 3466213 1.00 27.99 27.99 SHIPPING 0.00 PAINT TSI GAL IH RD 3449570 1.00 27.99 27.99 PAINT TSI GAL IH RD 3449570 1.00 27.99 27.99 TOTAL 117.46 SUBTOTAL 160.90 TAX 0.00 SHIPPING 0.00 TOTAL 160.90 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000863307010 431000862065010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 12.44 AMOUNT DUE: 39.99 Store: 574000431 INVOICE DATE: 08105 /08 Store: 574000431 INVOICE DATE: 07/31 /08 SMV METAL NEW LAW STYLE 2830037 1.00 12.44 12.44 SPRAY GUN METRIC W ADAP 3823821 1.00 39.99 39.99 SUBTOTAL 12.44 SUBTOTAL 39.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 12.44 TOTAL 39.99 V J Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 REMITTSC BUSINESS ACCOUNT PAYMENTS TO: Np TR CTOR SUPPLY COMPANY SDI 1% YCO P.O. Box 9020 Des Moines, IA 50368 -9020 Tractor Supply Company TSC TEAM MEMBER TO COMPLETE 2375 East Pleasant 60 Please include 16 Digit Account Number Noblesville, IN 46060 6035 301# (317) 776 -1883 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 624 624000081 2 1003442 08/06/2008 10:36am CUSTOMER TO COMPLETE 3807168 DISCONNECT 18IN WAND CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1100 23 23 .99 NT Government Asencies The undersigned certifies The undersigned party certifies their exemption from 3813127 BAND SAW BLADE 3/09 compliance with the agricultural payment of sales and use tax on tangible personal 1.00 e 20.99 20.99 NT sales tax exemption law of the state property as indicated below and /or purchaser is Government Asencies 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 Subtotal 44.90 Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00.'x. Tax 0,00 the applicable statement of the other agricultural production items purchased free of Total 44.98 respective state printed on the tax, as defined by state law, and as indicated below. TSC Card 44.98 reverse side of this form. Acct#: *V1$# **2*$$ *5866 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Auth$:006425 Ref #:0609354614 STATE: understand they may be liable for payment of all taxes PO t r shop (REQUIRED) due on the purchase price for the goods as allowed by Chance 0.00 (Exceptions: Georgia, New York Kentucky state law Should such goods be used or Consumed In Cash Back COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Buyer acknowledges the receipt of a comple Resale Under penalty of perjury, signee swears that d Government information on this statement is true and correct in copy of this sales slip and the Purchase o Exempt organization every material manner. A willfully false representatiod Agricultural Production of exemption will cause the purchaser to be subject to the described merchandise shall be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreement Livestock Production Floriculture /Aquaculture Production law' Other Sisnature; ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) F 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 Call 800 -968 -0734 within 7 days to Ingredieni or Component Parts (KS) complete a survey and be entered in a Other: monthly drawins for a chance to win a $2500 shoppins spree, (Awarded as Gift Card) NO PURCfIASE C MER 1 ATURE: QUIRED) MGR. APPROVAL X USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISAS MIC- DISCOVER TSG CHARGE ACCOUNT NO. CHG: EXCH. DATE? O L1 ITE NUMBER Form No. 99 -00401 (12105) CUSTOMER ORIGINAL FitMl l �G Dtl�711l7C.7.7 F4rrr`rVlJ1W 1 R PAYMENTS TO: TRACTOR SUPPLY COMPANY r O� YC® P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME 31': ADDRESS i CITY STATE ZIP PHONE Vii. ;i� t' CUSTOMER TO COMPLETE J 1 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 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 I indicated below and understands and agrees with the General engaged in the business of agricultural production of food or fiber, horticulture, aquaculture of floriculture for r' Exemption Statement at right and resale and /or uses the farm machinery, equipment or the applicable statement of the respective state printed on the other agricultural production items purchased free of I reverse side of this farm. tax, as defined by state law, and as indicated below. The under art further certifies the PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty they STATE: understand they may be liable for payment of all taxes V (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 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) I, Resale Under penalty of perjury, signee swears the D Government information on this statement is true and correct in I J•'' 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 Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock In)estibles or Injectibles Exempt Organization (Entity Fertilizer/Agrichemicals NC: only. DOT and US Government are exempt Resale (Sales Tax Permit Consumed in Production (KS) Ingredient or Component Parts (KS) °'kc' Li,.'. Other: CUS OMER SIGNATUR EQUIRED) MGR. APPROVAL X IJISE SHADED; AREA CASH BHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH.; DATE IT DE Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TWT PAYMENTS TO: TRACTOR SUPPLY COMPANY P 5�y Co P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS t( CITY STATE ZIP PHONE CUSTOMER TO COMPLETE 1 iii 1'• �i CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 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 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 the applicable statement of the other agricultural production items purchased free of 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 STATE: understand they may be liable for payment of all taxes REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia New Y a Kentucky state law should such goods be used or consurned in COMPLETE REVERSE SIDE) i a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) I C Resale Under penalty of perjury, signee swears the jVGovernment information on this statement is true and correct in it 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 Livestock Production law. Floriculture /Aquaculture Production 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 Consumed in Production (KS) In dient or Component Parts (KS) t l Other: US 0 ER IGNATURE:(REQUIRED) MGR. APPROVAL Q 7 X, ERATI CASH CHECK VISA M!C DISCOVER TSC CHARGE. ACCOUNT NO:, ITE Form No. 99 -00401 (12105) CUSTOMER ORIGINAL P IP REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR TRACTOR SUPPLY COMPANY i7su"LYCOM P,O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 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 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 the applicable statement of the other agricultural production items purchased free of respective state printed on the tax, as defined by state law, and as indicated below. reverse side of this form. PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Geor New York s Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. L PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in O 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 Livestock Production Floriculture /Acluaculture Production law' Other ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injectibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CUSTOME SIGNATU E. (REQUIRED) MGR. APPROVAL 4 X 'USE SHADED ONLY WHEN REGISTER IS INOPERATIVE CASH CHECK MC DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE DESCRIPTION ITE UNIT PRICE Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMITTSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY Co P.O. Box 9020 Des Moines, IA 50368 -9020 t TSC TEAM MEMBER TO COMPLETE ,please include 16 Digit Account Number 6035 301 NAME= cl ADDRESS 4 V 7 1 CITY STATE ZIP PHONE CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned. certifies The undersigned party certifies their exemption from 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 indicated below and understands engaged in the business of agricultural production of and agrees with the General 1 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and the applicable statement of the resale and /or uses the farm machinery, equipment or respective state printed on the other agricultural production items purchased free of I L reverse side of this form. tax, as defined by state law, and as indicated below. The under art further certifies the PRODUCT IS TO BE USED IN THE FOLLOWING g 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 by I (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. PURCHASER IS ENGAGED IN: (REQUIRED) 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 Agricultural Production. of exemption will cause the purchaser to bb subject to Dairy Production Livestock Production penalty and /or other provisions as allowed under state FloriculturelAquaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery /Repair Parts Government Agency (Entity livestock Iniestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals INC: only DOT and US Government are exempt Consumed in Production KS Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CUSTOMER SIG AT RE:(REQUIRED) MGR. APPROVAL X USESHADED AREA ONLY WHEN REGISTER� IS INOPERATIVEi 'CASH CHECK b 1 A M/C DISCOVER- I TSC CHARGE ACCOUNT NO CHG. EXCH. 'DATE a a o RW Form No. 99.00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY i C® P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield, IN 46074 6035 301 (317) 867 -3505 NAME CARMEL STREET DEFT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) S71 -2141 CITY STATE ZIP PHONE 431 431000179 2 865760 08/15/2008 02A7pm CUSTOMER TO COMPLETE 3566887 68 GALV AND COTTERPI 9.40 n 3.49 32.81 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Agencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 32,81 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00: Tax 0100 indicated below and understands Total 32,81 engaged in the business of agricultural production of and agrees with the General TSC Card 32.81 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Acct Y #3#YYYY#Y#16120 resale and /or uses the farm machinery, equipment or the applicable statement of the Autht:015443 Ref #:1513471107 respective state printed on the other agricultural production items purchased free of PO 4 :081508 reverse side of this form. tax, as defined by state law, and as indicated below. 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 rece' of a coot e (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 04 this sales slip an he Furcha5e o PURCHASER IS ENGAGED IN: (REQUIRED) f the described merchandis hall Resale Under penalty of perjury, signee swears the [I Government information on this statement is true and correct in accordance with she C rd Ider ement• 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 Signahlre: Livestock Production Floriculture /Aquaculture Production law. Other. ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Y# 2YYYL #3 #Y ##YY #2YYY88#Y ##EY8Y#8 Farm Machinery/Repair Parts Government Agency (Entity YY #YtEY #YY #YYY #8YY ##EY##t Livestock lnjestiblesorinjectibles. .Exempt Organization (Entity Call 800-968 °0734 within.7 days to NC: only DOT and US Government are exempt complete a .survey and be entered in a F7 Fertilize r/Agrichemicals monthly drawing for a chance to win a Consumed in Production (KS) Resale (Sales Tax Permit 2500 shopping spree Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE DR SURVEY NECESSARY. Ends 9/30/08, Other: i CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X USE SHADED ONLY •P CASH CHECK VISA M/C .DISCOVER TSCCHARGEACCOUNTNO. GHG: EXCH. DATE U 211111 M NUMBER Form No. 99-00401 (12105) 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)) 08/19/08 $139.88 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 VOUCH NO. WARRANT NO, ALLOWED 20 Tractor Supply 641 Z+ Q IN SUM OF P. O. Box -90= 6 Des Moines, IA 50368 -9020 $139.88 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 2201 42 -370-00 $139.88 1 hereby certify that the attached invoice(s), or 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 T ursday, August 28, 2008 Street Co sioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund