166924 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $1,941.28
s a CARMEL, INDIANA 46032 PO eox 689020
off DES MOINES IA 50368 -9020 CHECK NUMBER: 166924
CHECK DATE: 12110!2008
DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 603530120005 891.91 REPAIR PARTS
2201 4356001 603530120005 1,049.37 UNIFORMS
I
v A t
page t of 5 TX 7 D1130000000
7su"W
BUSINESS ACCOUNT
0000521
kACNT' S�1iV�MAt16y F fit13501 I}05 08►Q
N
M e
Previous Balance 937.07 Closing Date 11/19/08
Payments 181.01 Next Closing Date 12/18/08 CARMEL STREET DEPT
Credits 88.27 Payment Due Date 12/14/08 CINDY
Purchases 2,029.55 3400 W 131 ST ST
Debits 0.00 Current Due 1,941.28 WESTFIELD, IN 46074 -8267
FINANCE CHARGES 0.00 Past Due Amount 756.06 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 2,697,34 Credit Available 2,353
New Balance 2,697.34
CURRENT ACTIVITY
�ralaCtiOn CdtiON� AtrlOtJnf
NOV 6 GOODS AND SERVICES NOBLESVILLE IN 884.42
TOTAL 6035301200074795 $884.42
NOV 14 GOODS AND SERVICES WESTFIELD IN CREDIT 88.27
TOTAL 6035301200074803 $88.27
NOV 12 GOODS AND SERVICES WESTFIELD IN 122.22
TOTAL 6035301202895908 $122.22
NOV 13 GOODS AND SERVICES WESTFIELD IN 845.97
TOTAL 6035301202895973 $845.97
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daly Days in ANNUAL Balance Daily Days in ANNUAL
Subject to Periodic B llug PERCENTAGE Sul�ect to Periodic al PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN 0.00 .00000 29 0. 0o 0. 00000 33 0.00
This Account Issued by Citibank (South Dakota) N.A. CUSTOMER SER -1, 80 0 -559-13232 FAX NUMBER 1 B01- 779 -7425
Information About Your Account. purchases and an averagi daily balance method (including new transactions)
Grace Period on Purchases. You can avoid periodic finance charges on for cash advances. If your account is subject to a daily periodic rate we figure
purchases, but not on cash advances. This is called a grace period on the periodic finance charge by multiplying the daily balance by its daily
purchases. You can get a grace period of at least 20 days. To do so, pay the periodic rate. We do this for each day in the billing period. In addition, for each
following amounts by the due date every billing period: the New Balance purchase balance, we multiply the daily balance for each day of the previous
(subject to the Promotional Balance Exceptions), plus the minimum monthly billing period by its daily periodic rate. If your account is subject to a daily
payments required for your No Interest and 0% balances. If you do not, you periodic rate we figure the periodic finance charge by multiplying each
will not get a grace period unless you pay those amounts by the due date for Balance Subject to Finance Charge by its monthly periodic rate. In addition, we
two billing periods in a row. The two Promotional Balance Exceptions are: (1) multiply the Balance Subject to Finance Charge for each purchase balance for
You do not have to pay any No Interest or 0 0 /0 balances that do not expire by the previous billing period by its monthly periodic rate. Whether your account
the Next Closing Date shown on the billing statement. (2) You can pay any No is subject to a daily or a monthly rate, for each balance, we add up all the daily
Interest cr 0% balances that do expire by the Next Closing Date shown on the balances for the billing period and divide by the number of days in the billing
statement by the later of the promotion's expiration date or the statement's period. This gives us the Balance Subject to Finance Charge for that balance
payment due date. for that billing period. We do not calculate periodic finance charges for the
previous billing period if your account was credited for the full New Baianc-e,
Certain promotional offers may take away the grace period on purchases. plus the minimum monthly payments required for your No Interest and 0%
Other promotional offers may allow you to have a grace period on purchases balances, on your previous billing statement by that statement's payment due
without having to pay all or a portion of the promotional balance by the due date (subject to the Promotional Balance Exceptions described above in the
date. If either is the case, the promotional offer will describe what happens. Grace Period on Purchases) or a periodic finance charge was already billed on
that balance. If your account is subject to a daily periodic rate, for each cash
Balance Subject to Finance Charge. We calculate periodic finance charges advance balance, multiply the Balance Subject to Finance Charge by the
number of days in the billing period and by the applicable daily periodic rate.
separately for each balance. Balances include regular purchases, regular cash
advances, and different promotional balances. The result is the periodic finance charges for that balance. rah each purchase
balance, multiply the Balance Subject to Finance Charge for the current billing
To get a daily Balance, we start with the balance as of the end of the period by its daily periodic rate and by the number of days in the billing
previous day. We add any new charges. We then subtract any new credits or period. Then do the same thing for the Balance Subject to Finance Charge for
payments and make other adjustments. A credit balance is treated as a the previous billing period (if there is one) using the daily periodic rate and
balance of zero. If the rate on a Balance is a daily rate we include in the daily number of days in that billing period. Add the two results and you will have
balance any periodic finance charge on the previous day's balance. (This the total periodic finance charge for that balance. Rounding may cause a small
results in daily compounding of finance charges.) difference.
If the rate on a balance is a daily rate we use an average daily balance
method (including new transactions). We figure the periodic finance charge by Notify Us in Case of Errors or Questions About Your Bill. If you think your
multiplying the daily balance by its daily periodic rate. We do this for each day bill is wrong, or if you need more information about a transaction on your bill,
in the billing period. The Balance Subject to Finance Charge is the average of write us (on a separate sheet) at the Billing Errors address on this statement
the daily balances during the billing period. If you multiply this figure for each as soon as possible. We must hear from you in writing no later than 60 days
balance by its daily periodic rate and by the number of days in the billing after we send you the first bill on which the error or problem appeared. In
period, the result is the total periodic finance charge on that balance. your letter, give us the following information:
Rounding may cause a small difference. o Your name and account number.
Alternate Balance Sub to Finance Char Calculation Method. If the The dollar amount of the suspected error.
front of your statement has a message stating this account is subject to the Describe the error and explain, if you can, why you believe there is an
Alternate Balance Subject to Finance Charge Calculation Method we use a error. If you need more information, describe the item you are unsure
two-cycle average daily balance method (including new transactions) for about.
Important Payment Instructions. Copy Fee. We charge $5 for each copy of a billing statement that dates back 3
Crediting Payments. We must receive your payment in proper form at our months or more. We add the fee to the regular revolve credit plan balance. We
processing facility by 5 p.m. local time there. If we do, it will be credited as of waive the fee if your request for the Copy relates to a billing error or disputed
that day. A payment received at the processing facility in proper form after purchase.
that time will be credited as of the next day. Allow 5 to 7 days for payments by Payment Options Other Than Regular Mail.
regular mail to reach us. There may be a delay of up to 5 days in crediting a Pay by Phone Service. You may use this service any time to make a
payment we receive that is not in proper form or is not sent to the correct payment by phone. You will be charged $14.95 to use this service. Call by 5
address. The correct address for a payment sent by regular mail Is the address p.m. Eastern time to have your payment credited as of that day. If you call
listed on the return envelope or on the front of the payment coupon. A after that time, your payment will be credited as of the next day. We may
payment made in -store is not sent to the correct address. The correct address process your payment electronically after we verify your identity.
for a payment sent by courier or express mail is the Express Payments
Address shown below. Express Payments. You can send payment by courier or express mail to
Proper Farm. For a payment sent by mail or courier to be in proper form, you the Express Payments Address: Customer Service Center, Dept CCS 911,
must: 4740 121st Street, Urbandale, IA 50323. Payment must be received in roper
form at the proper address by 5 p.m. Central time to be credited as of that
Enclose a valid check or money order: No cash, gift cards, or foreign day. All payments received in proper form at the proper address after that
currency please. time will be credited as of the next day.
Include your name and account number on the front of your check or Report a Lost or Stolen Card Immediately. You may call Customer Service
money order. 24 hours a day, 7 days a week.
If you send an eligible check with this payment coupon, you authorize us
to complete your payment by electronic debit. If we do, the checking
account will be debited in the amount on the check. We may do this as Tractor Supply CRC 5603TV Rev. 07/08
soon as the day we receive the check. Also, the check will be destroyed. 603TV5740708 -Cit
page 2 of 5 Tx 7 D1130000000
®SUPPLY�
0000522 BUSINESS ACCOUNT
CURRENT ACTIVITY
Ta sacticrn Location
r •.a
OCT 30 GOODS AND SERVICES NOBLESVILLE IN 79.96
NOV 3 GOODS AND SERVICES WESTFIELD IN 11.99
TOTAL 6035301202896013 $91.95
NOV 10 GOODS AND SERVICES WESTFIELD IN 84.99
TOTAL 6035301202896146 $84.99
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
OCT 23 PAYMENT REF P91940OMTOA15JFK7 181.01
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!
This account is subject to the Alternate Balance Subject to Finance
Charge Calculation Method. See back for details.
Remit To: Bill To: Page 3 or 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860
DEPT.30- 1200050860 RON WILLIAMS ®SUMYC�
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000523
Payment Due Date: 12/14/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP To: INVOICE:
624001031088010 624001034555010
Purchase Order: Purchase Order:
100808 SCOTT
AMOUNT DUE: 322.47 AMOUNT DUE: 80.00
Store: 574000624 INVOICE DATE: 10/08 /08 store: 574000624 INVOICE DATE: 10/16/08
BIB SNDSTN LND 40X32 OL 7306732 1.00 84.99 84.99 SPECIAL ORDER PAYMENT 624052612 1.00 60.00 80.00
JKT THRML HD LG MOS CT6 7067516 1.00 72.50 72.50
BIB SNDSTN LN 40X32 BN 7048033 1.00 84.99 84.99 SUBTOTAL 80.00
SHOE CHORE HI BK 10 SN6 7015137 1.00 79.99 79.99 TAX 0.00
SHIPPING 0.00
SUBTOTAL 322.47
TAX 0.00 TOTAL 80.00
SHIPPING 0.00
TOTAL 322.47
\1
C
SHIP TO: INVOICE: SHIP To: INVOICE:
624001043857010 431000881314010
Purchase Order: Purchase Order:
RON TRUCK8
AMOUNT DUE: 884.42 AMOUNT DUE: 59.99
Store: 574000624 INVOICE DATE: 11/06 /08 Store: 574000431 INVOICE DATE: 10/20 /08
SWTSHIRT HOODED NV BST 7385532 25.00 19.19 479.75 BED MAT 8FT FORD 250 35 0184901 1.00 59.99 59.99
SWTSHIRT HOODED NV REGS 7385493 23.00 17.59 404.57
SUBTOTAL 59.99
SUBTOTAL 684.32 TAX 0.00
TAX 0.00 SHIPPING 0.00
SHIPPING 0.00
TOTAL 59.99
TOTAL 684.42
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 MR
DEPT.30 1200050860 JEFF STEWART ®SUMYC -o
PO BOX 689020 211 2ND ST SW
DES MOINES IA 50368 -J020 000052a BUSINESS ACCOUNT
ME Payment Due Date: 12/14/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
e SHIP TO: INVOICE: SHIP TO INVOICE:
431000887174010 431000886772010
Purchase Order:
131 SHELL
AMOUNT DUE: 88.27- AMOUNT DUE: 122.22
Store: 574000431 INVOICE DATE: 11/14 /08 Store: 574000431 INVOICE DATE: 11/12 /08
SLIP PLATE E2 SLIDE 12 2120034 13.00 6179 88.27 SLIP PLATE E2 SLIDE 12 2120034 18.00 6.79 122.22
SUBTOTAL 88.27 SUBTOTAL 122.22
TAN 0.00 TAX 0 -00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 88.27- TOTAL 122.22
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000886960010 431000878736010
Purchase Order: Purchase Order:
111308 100908
AMOUNT DUE: 845.97 AMOUNT DUE: 256.76
Stare: 574000451 INVOICE DATE: 11 /13 108 Store: 574000431 INVOICE DATE: 10109 /08
TANK STORAGE 155oGAL 2125652 1.00 579.99 579.99 PELLETS 40LB VW SURE SO 2169761 63.00 4.08 257.04
QUICK COUPLER 2IN PART 2121666 1.00 6.29 6.29
BALL VALVE 2IN BOLTED 2107557 1.00 36.99 36.99 SUBTOTAL 257.04
QUICK COUPLER 2IN PART 2121658 1.00 11.99 11.99 TAX 0.00
-MALE COUPLER 2IN- MNPT -3-- 2100759 1.00 26.99 26.91 SHIPPING 0.00
QUICK COUPLER 2IN DUST 2121705 1.00 10.99 10.99
QUICK COUPLER 2IN DUST 2121705 1.00 10.99 10.99 TOTAL 256.76
QUICK COUPLER 2IN PART 2121666 1.00 6.29 6.29
QUICK COUPLER 2IN PART 2121640 1.00 11.99 11.99
QUICK COUPLER 2IN DUST 2121705 1.00 10.99 10.99
QUICK COUPLER 2IN DUST 2121.690 1.00 7.49 7.49
TRAVELLER GREASE LITHIU 0804959 1.00 64.99 64.99
BED MAT 8FT FORD 250 35 0184901 1.00 59.99 59.99
SUBTOTAL 845.97
TAX 0.00
SHIPPING 0.00
TOTAL 645.97
V
V
Please Direct inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
Remit To: Bill To: page s or 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860`'�R"
DEPT.30 1200050860 MATT HIGGINBOTHAM ®S[JP'F'LYC2
PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000s25
Payment Due Date: 12114!08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP To: INVOICE:
624001033190010 624001041040010
Purchase Order: Purchase Order:
101308 103008
AMOUNT DUE: 98.86 AMOUNT DUE: 79.96
stare: 574000624 INVOICE DATE: 10/13/08 Store: 574000624 INVOICE DATE: 10/30 108
PUMP 12V 5.8GPM QUAD 2102222 1.00 48.86 98.86 BIB CRHT 1NSLTD BR 48X3 6311661 1.00 79.96 79.96
SUBTOTAL 98.86 SUBTOTAL 79.96
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 98.86 TOTAL 79.96
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000884578010 431000886292010
Purchase Order: Purchase Order:
110308 WINTERGEAR
AMOUNT DUE: 11.99 AMOUNT DUE: 84.99
Store: 574000451 INVOICE DATE: 11/03 /08 Store: 574000431 INVOICE DATE: 11/10/08
QUICK COUPLER 21N PART 2121640 1.00 11.99 11.99 BIB SNDSTN LN 36X52 BN 7048017 1.00 84.99 84.99
SUBTOTAL 11.99 SUBTOTAL 84.99
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 11.99 TOTAL 84.99
Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801- 779 -7425
REMITTSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
Su"L P.O. BOX 9020 Tractor SuPhl.r Company
1 Des Moines, IA 50368 -9020 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West F ield, IN 46074
6035 301 317) 967-3505
NAME CARMEL STREET DEPT
3400 W 131ST S1"
ADDRESS WESTFIELD IN 460748267
(317) 571 -2141
CITY STATE ZIP PHONE 431 431000179 2 886964
11/13/2008 02:08rm
CUSTOMER COMPLETE L-II 2 564Y, 1 1550 �L
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: t 00 La 379, X79,99 �1T
Government Agencies
The undersigned certifies The undersigned party certifies their exemption from 2111666 L 7CR Lu U.K ZIN Pn
compliance with the agricultural payment of sales and use tax on tangible personal 1.00 8 6.29 6.29 NT
sales tax exemption law of the state property as indicated below and /or purchaser is Governmen Agencies
indicated below and understands engaged in the business of agricultural production of 2107557 EAL.L VALVE 2IN ROLTE
and agrees with the General 1.00 12 36.99 36.99 NT
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for
p g resale and/or uses the farm machinery, equipment or Government Agencies
the applicable statement of the other agricultural production items purchased free of 2121658 QUICK COUPLER 2IN PA
respective state printed on the tax, as defined by state law, and as indicated below. 1100 8 11,99 11 99 NT
reverse side of this form. Government Agencies
PRODUCT ISM BE USED IN THE FOLLOWING The undersigned party further certifies they 1100159 MALE COUPLER 21N MNP
STATE: understand they may be liable for payment of all taxes 1.00 26.99 26.99 u4
(REQUIRED) due on the purchase price for the goods as allowed by Government Agent' ite5
(Exceptions: Geor New York Kentucky state law should Such goods be used or consumed In 2121705 QUICK COUPLEh 2IN DU
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 1.00 10.99 10.99 NT
PURCHASER IS ENGAGED IN: (REQUIRED) Government Agencies
Resale Under penalty of perjury, signee swears the 2121705 QUICK COUPLER 2.1N DU
Government information on this statement is true and correct in 1.00 2 10.99 10,99 NT
Exempt organization every material manner. A willfully false representation Government A5encie5
Agricultural Production of exemption will cause the purchaser to be subject to 2121666 QUICK COUPLER 2IN PA
Dairy Production penalty and /or other provisions as allowed under state 1.00 8 6.29 6.29 NT
Livestock Production law. Government Agencies
FloriculturelAquaculture Production 2121640 QUICK COUPLER 2IN PA
Other: 1 00 11.99 11 99 NT
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Government Agencies
2121705 QUICK COUPLER ZIN DU
Farm Machinery/Repair Paris Government Agency (Entity 1.00 P 10.99 10 .99 NT
Livestock lnjestiblesorinjectibles Exempt Organization (Entity Government Agencies
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt 2121690 QUICK COUPLER ZIN DU
Consumed in Production (KS) Resale (Sales Tax Permit 1. e 7 49 7,49 NT
Government Asencie5
Ingredient or Component Parts (KS) 0804459 TRAVELLER GREASE LIT
Other: 1.00 2 64.97 64.99 NT
Government Agencies
0184901 RED MAT OFT FORD 250
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL 1. L 59 59 ,99 NT
Gi;vet'nment ASencle5
c 7 j' Z X
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
o
filIAMIK ITEM NUMBER DESCRIPTION UNIT PRICE
a
No. ss -oo401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
NF T BACTO R PAYMENTS TO:
TRACTOR SUPPLY COMPANY
QWV yJ"O P.O. Box 9020 Tractor supply Comi�any
2375 East Pleasant St.
Des Moines, !A 50368 -9020 Noblesville IN 46060
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317) 776 1883
6035 301# CARMEL STREET DEPT
NAME 3400 tai 131ST ST
UESTFIELD IN 460748267
ADDRESS (317) 571 -2141
CITY STATE ZIP PHONE
624 624000081 2 1043857
11/06/2008 10:12aln
CUSTOMER TO COMPLETE 7385532 SWTSHIRT HOODED NV B
25,00 19.19 479,80 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res, Price: 23.99
Government Agencies
The undersigned certifies The undersigned party certifies their exemption from 7385493 SWTSHIRT HOODED NY R
compliance with the agricultural payment of sales and use tax on tangible personal 23.00 17.39 404.62 NT
sales tax exemption law of the state property as indicated below and /or purchaser is Res. Price: 21,99
indicated below and understands engaged in the business of agricultural production of Government Agencies
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 Subtotal 804,42
the applicable statement of the other agricultural production items purchased free of 7,00% Tax 0,00
respective state printed on the tax, as defined by state law, and as indicated below. Total 884,42
reverse side of this form. TSC Card 884,42
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Acc t 4795
STATE: understand they may be liable for payment of all taxes Autht:006554 Ref *:0609114953
(REQUIRED) due on the purchase price for the goods as allowed by PO ran
(Exceptions: Geor New York a Kentucky state law should such goods be used or consumed in Change 0.00
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Cash Back
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the Buyer acknowledges the receipt of a comp le
Government information on this statement is true and correct inted
Exempt organization every material manner. Awillfully false representation copy of this sales slip and the purchase o
Agricultural Production of exemption will cause the purchaser be subject tof
Dairy Production penalty and /or other provisions as allowed under state the described merchandise shall be in
Livestock Production law. accordance with the Cardholder Agreement.
Floriculture /Aquaculture Production
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) S i s n a t u r e:
Farm Machinery/Repair Parts Government Agency (Entity
Livestock lnjestibles 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) Call 800- 960-0734 within 7 days to
Other. complete a survey and be entered in a
monthly drawing for a chance to win a
C TOME RE: {REQ MGR. APPROVAL
USE SHADED AREA ONLY.WHEN REGISTER IS INOPERATIVE.
X
a „M /C DISCOVER. TSC CHARGE ACCOUNT N0.. CHG. EXCH'. DATE
CASH CHECK VISA
❑r�
D ESCRI P TI O N
Form No. 89.00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
Su"Lyco P.O. Box 9020
Des Moines, IA 50368 -9020 T r act or 1 Supp CN
91
TSC TEAM MEMBER TO COMPLETE 1 es tf U.5, 41 N orth
Please include 16 Digit Account Number W 46074
6035 301# (317) 867-3505
NAME
CARMEL STREET DEFT
3400 L) 131ST ST
ADDRESS UESTFTELD IN 460748267
(317) 571 -2141
CITY STATE ZIP PHONE
431 43100017;/ 2 887174
11/14/2008 01:55Pm
CUSTOMER TO COMPLETE 2120034 SLIP PLATE EZ SLIDE
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: -13,00 a 6.79 -88,27 NT
The undersigned certifies Governwent Agencies
g The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 88,27
sales tax exemption taw of the state property as indicated below and /or purchaser is ?,OW/ Tax 0.00
indicated below and understands engaged in the business of agricultural production of Total -88,27
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card -813.27
Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct #tats# #t #t #**4803
the applicable statement of the other agricultural production items purchased free of AutW Re+t.:
respective state printed on the tax, as defined by state law, and as indicated below. Chanse 0,00
reverse side of this form.
Cash Back:
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 Buyer acknowledses the receipt of a cL:' 1 +e
(REQUIRED) due on the purchase price for the goods as allowed by.-,
(Exceptions: Georgia, New York Kentucky state law should such oods be used or consumed In
COMPLETEAEVERSESIDE) g CUpr of ##'115 sales slit and the Purchase D
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 Asreewetlt,
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 Sisnature
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production
F1 Floriculture /Aquacullure Production law'
Other
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm MachinerylRepairParts Government Agency (Entity
Call 800- 968 -0734 within 7 days to
Livestock Injestibles or Injectibles Exempt Organization (Entity
NC: only DOT and US Government are exempt cunt fete a Survey and be enured in a
[D Fertilizer /Agrichemicals monthly da'awin9 for a cnanCe to win 8
Consumed in Production (KS) Resale (Sales Tax Permit $2.500 5happ ills Spree,
tAwarded as Gift Card) NO PURCHASE
Ingredient or Component Parts (KS) DR SURVEY NECESSARY. Ends 9/30/09,
Other:
C STO -ER IGNATURE:(REOUIRED) MGR. APPROVAL Enter Store t: 0431
TL
av 4 l- IZ b `Y &T
A ItIl 11 USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
S CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT N0. CHG. EXCH. DATE
Q
ITEM NUMBER DESCRIPTIO
Form No. 99- 00401 (12/05) CUSTOMER ORIGINAL
REMITTSC BUSINESS ACCOUNT
PAYMENTS To:
TRACTOR SUPPLY COMPANY
SWTI Lyco P.O. Box 9020 Tractor Supply CcmPany
Des Moines, IA 50368 -9020 18160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West#ield,IN 46074
6035 301# (3 t 7) 867 -3505
NAME CARMEL STREET DEFT
3400 W 131sT ST
ADDRESS WESTFIELD TN 460748267
(317) 571 -2141
CITY STATE ZIP PHONE 431 431 000 47 2 806 772
11/12/2008 02: 14p of
CUSTOMER TO COMPLETE 21? t IF' PLATE Ez SLIDE
0 6,79 122.22 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: j e t Aseticies
The undersigned cert ifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 122.22
sales tax exemption law of the state property as indicated below and /or purchaser is .00% 1 ax 0.00
indicated below and understands TD i a I
engaged in the business of agricultural production of t 122.22
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card 122 22
Exemption Statement at right and resale and/or uses the farm machinery, equipment or Acct�t: ;r,.;E $x3335808
the applicable statement of the Autht:012252 Refo.1 21 31 35290
respective state printed on the other agricultural production items purchased free of P ;.;131 SHELL
reverse side of this form, tax, as defined by state law, and as indicated below. Change
0.00
PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Bzic k
STATE: understand they may be liable for payment of all taxes
(REQUIRED) due on the purchase price for the goods as allowed by ��IVer ackn�,wled9es the receipt o f a conlP le
(Exceptions: Georgia, New York S Kentucky state law should such goods be used Or consumed W d
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. cooly Of this Sales slip and the PUrchase O
PURCHASER IS ENGAGED IN: (REQUIREO) the described werchandise 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 Asreenien t
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
law.
F Floriculture /Aquaculture Production
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) $3 #3$ 383$333# #$13333 #YE333$ #E #t;#
Farm Machinery/Repair Parts 0 Government Agency (Entity 3;#3 tt #t33 ;S3$3333E33 #3 ;#38 #Y #$E;#
Livestock injestibles or Injectibles Exempt Organization (Entity Call 800 968 0734 within 7 days to
Fertilizer /Agrichemicals NC: only DOT and Us Government are exempt coop fete a survey and be entered in a
Resale (Sales Tax Permit# monthly drswios for a chance to win a
F Consumed in Production (KS) $2500 Shoppins spree.
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
F7 Other:
OR SURVEY NECESSARY, Ends 9/30/09,
33# 3E3 #'3333333A #3E #3 #X #t ##33E3
CUSTOMER IGNATURE:( RED) MGR, APPROVAL
X
SHADE USE AREA ONLY
CASH WCHVISA MX; DISCOVER TSC CHARGE ACCOUNT N0. CHG, EXCH. DATE
r ITEM NUMBER DESCRIPTIO
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
�R®
PAYMENTS TO:
Tl
TRACTOR SUPPLY COMPANY
10 CO P.O. Box 9020 Tractor Supply Company
Des Moines, IA 50368 -9020 2375 East Pleasant St. Noblesville, IN 46060
TSCTEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317) 776 -1083
6035 301
NAME CARi9EL STREET DEPT
3400 W 131ST ST
WESTFIELD IN 460748267
ADDRESS (317) 571 -2141
CITY STATE ZIP PHONE 624 624000104 2 1041040
10 /30 /200B 02:05pm
CUSTOMER TO COMPLETE 631 BIB C RHT INGLTB BR 4
1.00 e 79.96 79,96 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
The undersigned certifies The undersigned party certifies their exemption from Subtotal 79.96
compliance with the agricultural payment of sales and use tax on tangible personal 7,00% Tax 0100
sales tax exemption law of the state property as indicated below and /or purchaser is Total 79,96
indicated below and understands engaged in the business of agricultural production of TSC Card 79.96
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Acct E E E E #6013
Exemption Statement at right and resaje and /or uses the farm machinery, equipment or Auth# :03077$ Ref# :3013051209
the applicable statement of the other agricultural production items purchased free of PO 4 :103008
respective state printed on the tax, as defined by state law, and as indicated below. Change 0,00
reverse side of this form.
Cash Back
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 Buyer acknowledges the receipt Of a ple
(REQUIRED) due on the purchase price for the goods as allowed by t ed
(Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in
COMPLETE REVERSE SIDE) CDPY Of this sales 51iN and the Purchase D
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 Asr ement.
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 Sisnatcsre:
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production
law'
Floriculture /Aquaculture Production
Other:
ITEMS PURCHASEDWILL BE USED FOR:(REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Call 800- 968 -0734 within 7 days to
Livestock lniestiblesoriniectibles Exempt Organization (Entity complete a survey and be entered in a
NC: only DOT and US Government are exempt
F7 Fertrlizer /Agrichemicals fllOnt'h1Y draWln9 for a Chance t0 win a
Consumed in Production (KS) D Resale (Sales Tax Permit $2500 ShoPP ins spree.
Ingredient or.Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/09,
0 Other:
CUSTOMER SIGNATU le tll MGR. APPROVAL
USE
SHA DED NLY WHEN REGISTER IS INO PERATIVE.
CASH CHECK MIC DISCOVER TSC;CHARGE ACCOUNT NO, CHG EXCH. DATE
QUANTITY ATEM NUMBER DESCRIPTIO
CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
T RUTO R
TRACTOR SUPPLY COMPANY
SU �'CO- P.O. Box 9020 1'r•actor supply Company
Des Moines, IA 50368 -9020 1B160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield. IN 160 ?4
6035 301 (317) SST -3505
NAME CARMEL STREET DEFT
3400 W 131ST ST
ADDRESS
4lESTFIELD IN 460748267
(317) 571 -2141
CITY STATE ZIP PHONE 431 431000179 2 884578
11/03/2008 03:00p1I3
CUSTOMER TO COMPLETE 2121640 QUI COUPLER 21N PA
1,00 11.99 11.99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Governclent 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 11.99
sales tax exemption law of the state property as indicated below and/or purchaser is 7.00Z Tax 0.00
indicated 'below and understands Total. 11.99
engaged in the business of agricultural production of
and agrees with the General at right and TSC Card 11 .5`9
Exemption Statement food or fiber, horticulture, aquaculture of floriculture for Acct& i ii i i #6013
resale and /or uses the farm machinery, equipment or
the applicable statement of the other agricultural production items purchased free of Auth *:003467 Ref *:0313002272
respective state printed on the g p p PO s:11030i3
reverse side of this form. tax, as defined by state law, and as indicated below. Change
0100
Thndersi ned art further certifies they
Cash Back
The u
PRODUCT IS TO BE USED IN THE FOLLOWING 9 party
STATE: understand they may be liable for payment of all taxes Buyer acknowledges the receipt Of a cie
(REQUIRED) due on the purchase price for the goods as allowed by
(Exceptions: Georgia, New York &Kentucky
i
state law should such goods be used or consumed tt.d
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. C °pr Of this sales s l i p and the Purchase O
f
PURCHASER IS ENGAGED IN: (REQUIRED) the described ElIErChd 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 Asreehient.
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
law.
Floriculture /Aquaculture Production
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm MachlnerylRepair Parts Government Agency (Entity
Livestock Call 800. °968 -0734 within 7 days to
1 1 Exempt Organization (Entity
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt carewlete is Survey and be entered in a
Resale (Sales Tax Permit# rilonthl.y drawing for a Chance t0 win a
Consumed in Production (KS) $2500 shopping spree,
Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/09,
Other.
7
CUSTOMER SIGNATURE: (REO IRED) MGR. APPROVAL
0
CASH CHECK we 'DISCOVER TSC CHARGE ACCOUNT NO. CHG. -EXCH. DATE
O
a
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
5VVy CO P.O. Box 9020
Des Moines, IA 50368 -9020 Tr actor 16160 tf 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wes t r ield, IN 46074
6035 301 317) 867 -3505
NAME
CARMEL STREET LEFT
3400 W 131ST ST
ADDRESS WE.STFIELD IN 460743267
(317) 571 -2141
ciry srnrE ZIP PHONE 431 431000147 2 386191
11 ✓10/2006 01:56rn1
CUSTOMER TO COMPLETE 7048017 BIB SNDSTN LN 36X32
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 00 3 Ben 84,99 N1
Gov rnn;ent A sencies,
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 84.99
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 84,99
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card 84.99
Exemption Statement at right and resale and /or uses the farm machinery, equipment or Accte-: #6146
the applicable statement of the other agricultural production items purchased free of Atktht:010236 Reft:1012555234
respective state printed on the tax, as defined by state law, and as indicated below. PO 4 WINTERGEAR
reverse side of this form. Chanse 0,00
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Gast, 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 acknowledses the receipt of a con;rle
(Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed IGF d
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. corn a "f this sales slip and the purchase u
PURCHASER IS ENGAGED IN: (REQUIRED) f
Resale Under penalty of perjury, signee swears the the described merchandise shall be in
Government information on this statement is true and Correct in accordance with the Cardholder Asreelnent,
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to
El Dairy Production penalty and/or other provisions as allowed under state Sisnature:
Livestock Production
Floriculture /Aquaeulture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Iniestibles or Injectibles Exempt Organization (Entity Call 800 968 -0734 within 7 days to
Fertilize r /Agrichemicals NC: only DOT and US Government are exempt coinplete a survey and be entered in a
Consumed in Production (KS) Resale (Sales Tax Permit# monthly drawin i for a chance to win a
$2500 shoppins spree,
Ingredient or Component Parts (KS) (Awarded as Gift Caryl) NO PURCHASE
Other: OR SURVEY NECESSARY, Ends 9130 109,
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
X
USE SHADED AREA ONLY
CASH CHECK VISA M!C DISCOVER TSC CHARGE ACCOUNT NO. CHG- EXCH. DATE
O
ITEM DESCRIPTIO NUMBER
Form No. 99-00401 (12105) CUSTOMER ORIGINAL
ARKANSAS: I he cu slums, as indicated by their signature an the reverse. certifies that he/she is engaged in the bl- ISOOsS of farming and the farm machinery and equipment purchased
will be used exclusively and directly in the agricultural production of food or fiber as a business. The reverse signed is aware that any false representation made by them In an atie_rn pt f
purchase farm machinery and equipment free from Arkansas Sales Tax is a rn €sdemeanor.
GEORGIA: The reverse signed hereby corlihes that all tangible personal property purchased or leased after the reverses indicated date will be purchased of leased far the purpose
indicated below, unfess otherwise specified on a particular order, and [hat the purchases a used as a part at a pursuit engaged in for profit. This certificate shall remain in effect until
revoked in vriling. Any tangible personal properly obtained under this certificate of exemplion is subject to the sales and use tax if it is used or consumed by the purchaser in any mann
other than indicated on this certificate. (Check proper box.)
-FARM MACHINERY AND EOUIPMENT-
t. Rubber -tired farm tractors and attachments which will be used exclusively in tilling. planting, cultivating or harvesting farm crops for sale. Such crops will be ptanfed and harvested
w €thin a twelve -month period. O.0 -G -A. 48 -8- 3(29)(1)
2. Machinery and /ar equipment which will be .sad r on file farm directly ill the p eduction of poultry or .eggs for sale. O- C.G.A. 48- 8- 3(29)(A)
3. Machinery and /c, equipment which will be used on the farm directly to the production, processing or storages of fluid milk for sale. O.C.G -A_ 48 -8- 3(29)(0)
d. Machinery andier equipment which will be used on the farm directly in the production of livestock for sale. O- C -G.A. 48- 8- 3(29)(D)
5. Machinery and 0, equipment which will be used on the faun directly in h.—csting farm craps grown and used on the (arm as teed for poultry or livestock by a producer fallinq
under the categories 2. 3, or 4 above. O.C.G -A- 48- 8- 3(29)(E)
6. Machinery and!or equipment which will be used in the hatching and breeding of poultry and livestock for sale. O.C.G.A. 48-8 3(29)(13)
7. Machinery and /or equipment which will be used in tilling the soil or in anima€ husbandry. O- C -G -A. 48- 8- 3(29)(F) -(G) (H)
B. Machinery and /or equipment which will be used exclusively to, irrigation of farm crops grown for sale including, but not limited to fruit, vegetable and nut crops.
O.C_G.A.§ 48 -a -3(26)
9. Pecan sprayers, pecan shakers and /or other equipment used in harvesting paeans. O.0 -G.A. 46- 8- 3(29)(J)
10, Lquipment which will be used on the farm exclusively in processing onions. O- C -G -A. 46 -8- 3(29)(1)
TIMSER EQUIPMENT AND RELATED ATTACHMENTS-
1 I Off -road equipment and related attachments which will be used exclusively in the site preparation, planting, cultivation, or harvesting of timber. This shall include all o1f-road
equipment and related attachments used in every forestry precodure starting with the severing of a tree from the ground until and 'including the point at which the Lief: or its
parts to any form has been loaded in the field in or on a truck or other vehicle for transport to the place of use. O.C.G -A. 48- 8- 3(25).1)
LIVESTOCK, SEED, FERTILIZER, FEED, PACKAGING, ETC
12. Collis, hogs, sheep• bursas, poultry, and bees when sold for breeding purposes. O.C.G.A. 48 -e -3(28)
f 13, Send, seedlings, fertilizers, insecticides, fungicides. roderreides, herbicides, defoliants, ..it tumigants, plant growth regulating chemicals, desiccants (including shavings and
sawdust from wood, peanut hulls, fuller's earth, straw and hay) and food for livestock, fish or poultry when used either directly in tilling the seller in animal, fish or poultry
husbandry: and /or, nonreturnable materials used for packing farm products for shipment or sale. O- C.G -A. 48 -8 -3(25) (35) (A) (Iii)
-FUELS USED IN POULTRY STRUCTURES ELECTRICITY USED IN IRRIGATION OF FARM CROPS-
14_ The sale of electricity for the operation of an irrigation system which is used on a farm exclusively for irrigation of farm crops when separately metered. O.C.G -A, 48 -8 -3(64)
f5. Liquefied petroleum gas or other fuel used in a structure in which broilers. pullets. or other poultry are raised when separately metered. O.C.G -A- 48 -8 -3(49)
ILLINOIS: The reverse signed hereby certifies that the property purchased wilt be used primarily in production agriculture or in State or Federal agriculture programs. Any farm chemicals
purchased a exempt are such pursuant to ',action 130.1955.
KENTUCKY: The reverse signed hereby certifies that they are a farmer regularly engaged in the occupation of! (farmer must initial appropriate line(s))
tilling arid cultivating the soil for the. production of crops:
raising and feeding livestock er poultry the products of which ordinarily constitute food for human Consumption; or
raising and feeding fames, alpacas, ratites, buffalo, or aquatic organisms.
The revers. signed also certifies that the tangible personal property purchased as indicated below will be used for the exempt purpose(s) provided for arnder KRS 139 -480.
Farmer must INITIAL approprlate triii
Being twine and wire
Farm chemicals
Farm machinery, attachments and repair /replacement parts therefor
Farm work Stock
Feed and lead additives
Gasolme, special fuels, natural gas or liquefied petroleum gas
Livestock or poultry the products of which ordinarily constitute food for human consumption
Ratites, llamas, alpacas, buffalo, or aquatic organisms
Machinery, equipment, attachment- and ropair/roplacem.ni pans there!., to be incorporated into an ill ing on -Farm grain /soybean facility and poultry, livestock, ratite, llama,
alpaca, or aquaculture facilities
Seed or fertilizer
_Materials to be incorporated into the renovation cr repair of an existing on -farm gr mi —ybaan facilities and poultry, livestock, ratite, llama, alpaca, or ,qu.ccltuno facility.
Water used in the production of crops as a business or in the raising of livestock /poultry, ratites, (lamas, alpacas, buffalo, aquatic organisms and dairy cattle.
SEE RFVERSE SIDE_ SP-E REVERSE SIDE
Signature Data
MICHIGAN: The reverse signed hereby certifies that all items, except as Indicated, are purchased for use or consumption in connection with the production of horticultural or agricultural
products as a business enterprise, and agrees to reimburse the seller the sales tax if used or consumed otherwise. Unlawful use of this certificate subjects persons to the penalties of the
sales tax acf_
NORTH DAKOTA, SOUTH DAKOTA: The purchases made herein are subject to the 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. -061 or 1 -083.
TEXAS CERTIFICATION OF EXEMPTION
Purchaser's name SEE REVERSE SIDE_
Street Address SEE REVERSE SIDE
City, state, zip code SEF REVERSE SIDE
I Claim an exemption from payment of sales and use taxes for the purchase of taxable items described below or on the attached order or invoice:
SEE REVERSE SIDE
Description of items (or an attached order or Invoice) to be purchased:
SEE REVERSE SIDE
I claim this exemption for the following reason:
SEE REVERSE SIDE
I understand that I will be liable for payment at solos tax which may become due for failure to comply with the provisions of the Tax Code: Limited Safes- Excise, and Use Tax Act,
Municipal Sales and Use "Tax Act, Sales and use Taxes for Special Purpose Taxing Authorities, County Sales and Use Tax Act, County Roam, Services Sales and Use Tax and the
Texas Health and Safety Code: Special Provisions Relating to Hospital Districts, Emergency Services Districts, and Emergency Services Districts in counties with a paputation of 125, 000
or less. Liability for the tax will be determined by the price paid for the taxable items purchased or the fair market rental value for the period of time used.
I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items which I know, at the time of pfarchase, will be used in a manner other than that
expressed in this cedificat.-
Seiler: SEE REVERSE SIDE
Street address SEE REVERSE SIDE
City, state, zip code: SIDE
Purchaser's signature: SEE RFVF_RSE SIDE Data: Phone:
Title: SEF RFVFRSF- S11DE
This certificate does riot require a aunll>or to be valid.
Sales and use tax exemption numbers or tax exempt numbers do not exist.
This cenlficate Should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public A.... nts.
Effective Date September 10, 1991 Rule 3.287
NEW YORK STATE DEPARTMENT OF TAXATION AND FINANCE NEW YORK STATE AND LOCAL SALES AND USE TAX
FARMER'S EXEMPTION CERTIFICATE
'lo purchasers and setters: To be completed by the farmer, given to and retained by the seller. To have a valid certificate, all entries must be completed.
Read aft instmctions carefully before completing or accepting this certificate.
To safe Is: You may net accept this certificate as the basis for selling exempt from tax the properly or services listed below, Tax must be col €ected on such sales.
Tail certificate may not bi, used to cfairtt exemption for the foflowirfg.
1 utilities, fuel oil, motor fuel or diesel fuel; 2. labor charges in connection with repair, maintenance of or service to real property: 3. tangible personal property incorporaled into a building,
structure, silo foundation or other capital improvements to real properly (excluding grape trellises and the remaining portions of a silo); 4. motor vehicles; or 5. property listed as taxable.
Name of seller TRACTOR SUPPLY__ COMPANY AFFILIATES Attn: Name of Farmer ___SEE REVERS SID
Street address 200 Pooli PlaCO Street address SEE REVERSE SIDE
w
C lty Brentwood _State TN ZIP Code 37027 City__ SEF REVERSE SIDE state LIP Code
Check applicable box: 21 Single Purchase Certificate O Rlanket Certificate
I, the reverse signed hereby certify that I am exempt from payment of the sales and use tax on tangible personal property purchased from you because the properly is to be used for
an exempt purpose and that certain services are also exempt -ban performed on an exempt property. (Check applicable box or boxes-)
L�] (a) Tangible personal property, except property Incorporated Into a building or structure, for use or Consumption directly and predominately in the production of tangible
persona§ property for sale by farming, Including stock, dairy, poultry, fruit, fur bearing'animal, and truck farming. The term farmfng 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.
(b) Tangible personal property for use in erecting, adding to, offering or improving a silo used in farming to make and store silage on a farm, provided such tangible
personal property Is to become an integral component part of such silo- (This exemption does not apply to tangible personal property used In constructing a silo
foundation.)
D (C) Posts and wire for use In constructing or maintaining vineyard trellises used in growing grapes for sale
1_I (d) Services of installing, repairing, maintaining and servicing exempt tangible personal property- (This exemption is provided for both state and local sales and use tax
with the exception of the tax Imposed by or fo r New York City.)
These Slat eme of. are made with the knowledge that willfully issuing a false or fraudulent certificate with the intent to evade tax is a misdemeanor undo, ...lien '1817(m) of the New
YoAk State Tax Law and sec &on 210.45 of the penal law punishable by a fine of not more than $1,000, or imprisonment for not more than a year or both,
Signature of farmer or farmer's representative (state title and relationship) SE F_ REVERSE SIDE Uate
Seller The tax exemption for farmers is limited to the purchase. of (1) tangible personal property used directly and predominantly in the production phase at farming and (2) the services
described in (d) related to [hat property. Purchases for use in administration, storage or marketing or purchases of tangible personal property used indiroctly in terming would not qualify.
(Sex, Publication 844, Sales Tax /nil rrnation for Fanners, for a complete explanation of the tax treatment of farmers purchases and sales.)
For your protection, a farmer must give you tills certificate net later than 90 days after delivery of the property sold or services rendered. If you have not received this certificate within 90
days of the date. of sale. the sale will be deemed to have been taxable at the itrne the transaction took place and the burden of proving it was not. shall be upon both you and the purchaser_
If the blankel,certificate box is checked, you may consider this certificate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives
you written notice of. revocation, or until the Tax Depariefent notifies you that the purchaser may not make exempt purchases.
Purchaser You must pay tax on utilities (telephone, telegraph, electricity or gas service) heating oil, motor fuel and diesel motor fuel at the time of purchase and claim a refund for any
exempt use. (If.you ate.l!iiri:hasi ng diesel motor fuel for exclusive consumption in farm machinery used to produce tangible personal property for sale, you may use Form FT -1004.
Farmers Exemption Cerfifrcate for Purchases of 01 ..If Motor Feel to purchase that fuel exempt
if the blanket,3erlificate box is checked, you may consider dhi5 certificate pan or any order received from the purchaser. A blanket certificate remains In force until the purchaser gives
year written notice of revocation, or until the Tax Department notifies you that the purchaser rnay not make exempt purchases.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Tractor Supply
IN SUM OF
P. O. Box 9020 �O J
D
Des Moines, IA 50368 -9020
$1,941.
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member:
2201 43- 560.01 $1,049.37 1 hereby certify that the attached invoice(s), or
2201 42-370.00 $891.91
bill(s) is (are) true and correct and that the
j� materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, December 04, 2008
c
Street Commi ner
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))
11/30/08 $1,049.37
11/30/08 $891.91
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