159099 04/30/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $776.58
�..j' CARMEL, INDIANA 46032 PO BOX 689020
DES MOINES !A 50368 -9020 CHECK NUMBER: 159099
CHECK DATE.: 4/30/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 STREET 55.37 6035301200050860
2201 4237000 STREET 124.37 6035301200050860
:2201 4238000 STREET 835.88 6035301200050860
2.201 4239032 STREET 239.04 6035301200050860
I
page 1 of 5+ TX 7 D 1 o 0 1�1/��
i Via
a ®SUMYCO—
�n
BUSINESS ACCOUNT
0000528
ACCQUNT SUMMARY p is, 035 301 Q005 0860 x
Previous Balance 1,011,08 Closing Date 04/18/08
Payments 1,141.08 Next Closing Date 05/19/08 CARMEL STREET DEPT
Credits 239.04 Payment Due Date 05/13/08 CINDY
Purchases 1 015.62 3400 W! 131ST ST
Debits 0.00 Current Due 646.58 WESTFIELD, IN 46074 8267
FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 646.58 Credit Available 4,603
New Balance 646. 58
CURRENT ACTIVITY
Transaction Location/ Amtaunt
Date N r
MAR 26 GOODS AND SERVICES HESTFIELD IN 12.38
MAR 26 GOODS AND SERVICES HESTFIELD IN 42.99
MAR 31 GOODS AND SERVICES GREENFIELD IN 769.92
APR 3 GOODS AND SERVICES HE9TP'IELD IN 65.96
TOTAL 6035301200074803 $891.25
MAR 21 GOODS AND SERVICES HESTFIELD IN CREDIT 239.04
TOTAL 6035301200074837 5239.04
MAR 19 GOODS AND SERVICES HESTFIELD IN 16.46
TOTAL 6035301202896054 $16.46
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daily Days in ANNUAL Balance Daily Day s in ANNUAL
Subject to Periodic Bill PERCENTAGE Subject to Periodic Billing PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN D. DD 00000 30 0.00 0.00 .00000 29 0.00
This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1 -800- 559 -8232 FAX NUMBER 1- 801_779 -7425
Notify Us in Case of Errors or Questions 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
It 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: n 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. a 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:
o Enclose a valid check or money order. No cash, gift cards, or foreign
currency please.
o Include your name and account number on the front of your check or
money order.
Tractor Supply Co. Full Balance S902TV 10106
902TV5741006 PCT
page 2 of 5 Tx 1 D 1 3D000000
A. TMTOR
SUMYCO-
�r
BUSINESS ACCOUNT
0000529
CURRENT ACTIVITY
Transaction r f L4cationl m
g•
lla #e �scr�ioi .uu,
.vf r
MAR 28 GOODS AND SERVICES WESTFIELD IN 14.87
APR 10 GOODS AND SERVICES WESTFIELD IN 49.71
TOTAL 6035301202896120 $64.58
MAR 31 GOODS AND SERVICES NOBLESVILLE IN 43.33
TOTAL 6035301202896211 $43.33
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
MAR 20 PAYMENT REF P91940OF009SVVMZJ 880.70
APR 17 PAYMENT REF P919400FW09XPYR93 260.38
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."
Remit To: Bill 1Ot page 3 of 5
-n TRACTOR,SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 T0R
DEPT.30- 1200050860 JEFF STEWART ®SUMYCO-
PO BOX'689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000530
Payment Due Date: 05/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000826377010 431000826362010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 42.99 AMOUNT DUE: 12.38
Store: 574000431 INVOICE DATE: 03/26 /08 Store: 574000431 INVOICE DATE: 03126 /08
ALUM OXIDE ABRASIVE SOL 3907950 1.00 42.99 42.99 WD40 GALLON 0134312 1.00 12.38 12.38
SUBTOTAL 42.99 SUBTOTAL 12.38
TAX 0.00 TAX 0100
SHIPPING 0.00 SHIPPING 0100
TOTAL 42.99 TOTAL 12.38
V
SHIP TG: INVOICE: SHIP TO: INVOICE:
576000609354010 431000828253010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 769.92 AMOUNT DUE: 65.96
Store: 574000576 INVOICE DATE: 03/31 /08 store: 574000431 INVOICE DATE: 04/03108
7 IN BANDSAW W BASE 3805093 1.00 749.99 749.99 MH HAMMER 2402 BALL PEE 3808473 1.00 15.98 15 -98
BAND SAW BLADE 374X93X. 3813127 1.00 19.93 19.93 CLAMP WELDING 2AXIS 3810713 1.00 24.99 24.99
CLAMP WELDING 2AXIS 3810713 1.00 24.99 24.99
SUBTOTAL 769.92
TAX 0.00 SUBTOTAL 65.96
SHIPPING 0.00 TAX 0100
SHIPPING 0.00
TOTAL 769.92
t`I TOTAL 65.96
V
S
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
Remit To: Bill To: Page 4 or 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 ToR
DEPT.30 1200050860 ERIC RUSSELL 1 0 SUM 0 2
PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000531
Payment Due Date: 05/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
o:
SHIP TO: INVOICE: SHIP To: INVOICE:
431000825287010 624000931813010
Purchase Order:
31808
AMOUNT DUE: 239.04- AMOUNT DUE: 11.28
Store: 574000431 INVOICE DATE: 03/21 /08 Store: 574000624 INVOICE DATE: 03/18 /08
TPOST 8FT 1.25 ON 3609146 46.00 4 -98 239.04 TAPE TEFLON 1 /2X260IN 3149926 1.00 1.30 1.30
QUICK COUPLER 2IN OUST 2121705 1.00 9.98 9.98
SUBTOTAL 239.04
TAX 0.00 SUBTOTAL 11.28
SHIPPING 0.00 TAX 0.00
SHIPPING 0.00
TOTAL 239.04
TOTAL 11.28
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000824767010 431000826765010
Purchase Order: Purchase Order:
21908 SHOP
AMOUNT DUE: 16.46 AMOUNT DUE: 14.87
Store: 574000431 INVOICE DATE: 03/19 108 Store: 574000431 INVOICE DATE: 03/28 108
QUICK COUPLER 2IN PART 2121640 1.00 10.98 10.98 5PK 4X1 /4X5 /81N DEPRESS 3903354 1.00 5.76 5.76
NIPPLE MALE TPT 2 2110681 1.00 2.99 2.99 WHEEL 4X1 /16X5 /8 CUTOFF 3816808 1.00 1.69 1.69
NIPPLE MALE TPT 1 1/2 2110673 1.00 2.49 2.49 RAIN CAP 2IN 0235346 1.00 7.42 7.42
SUBTOTAL 16.46 SUBTOTAL 14.67
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 16.46 TOTAL 14.87
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425
Kern it I o: Bill To: Page 5 or 5
=b TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 R 1
DEPT.30 1200050860 MIKE HENRICKS ®SUMYCO-
PO 130)( 689020 3400 W 131 ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000532
Payment Due Date: 05/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
v
SHIP TO: INVOICE: SHIP. TO: INVOICE:
431000830160010 624000937478010
Purchase Order: Purchase Order:
41008 33108
AMOUNT DUE: 49.71 AMOUNT DUE: 43.33
Store: 574000431 INVOICE DATE: 04/10 /08 Store: 574000624 INVOICE DATE: 03/31 /08
PAINT ENAMEL HARDNER HP 3449669 1.00 10.98 10.98 SPRING C363 UTILITY EXT 3534113 1.00 19.92 19.92
PAINT T8I GAL GLOSS BK 3449392 1.00 25.98 25.98 SPRING 0363 UTILITY EXT 3534113 1.00 19.92 19.92
56OBC 4X4 FS HINGE PS 3542085 1.00 4.25 4.25 HOSE END 1/4X3 /8IN MALE 3314385 1.00 3.49 3.49
560BC 4X4 FS HINGE PS 3542085 1.00 4.25 4.25
56OBC 4X4 FS HINGE PS 3542085 1.00 4.25 4.25 SUBTOTAL 43.33
TAX 0.00
SUBTOTAL 49.71 SHIPPING 0.00
TAX 0.00
SHIPPING 0.00 TOTAL 43.33
TOTAL 49.71
J
J
Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425
v-,
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
&I� P.O. Box 90 5(!rrl;' Cn,r
Des Moines, IA 50368 -9020 (_tau J;:', 3 i ;'r•sI h
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301
NAME S1 tie I:.. i ')F I-
1;CPli i) i31L- S!
ADDRESS
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE
1,0_ C ;2.4
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT 13ot r 214 i1 is 1.L
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural :IL i ui ii
sales tax exemption law of the state payment of sales and use tax on tangible personal 5 4 (j
property as indicated below and /or purchaser is f
indicated below and understands
engaged in the. business of agricultural production of
and agrees with the General: r :l 42. ,'y
food or fiber, horticulture, aquaculture of floriculture for ryr
Exemption Statement at right and LLC �,JS
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 F U -1: Lit
reverse side of this form. tax, as defined by state law, and as indicated below. tslh -3 0,00
PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they C h k
STATE: understand they may.be liable for payment of all taxes _�L
(REQUIRED) due on the purchase price for the goods as allowed by,
(Exceptions: Georgia, New York Kentucky state law should such g oods be used or consumed in
COMPLETE REVERSESIDE) g Jr S' ac iir. *s .U` 1 ic; %r,t ;:.!,.F U
a taxable manner as defined by state laws. :g
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in ,:rcr_Ir�c i V t. ,i, ,t, ;I J, itrl
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to
[D Dairy Production
E] Livestock Production penalty and /or other provisions as allowed under state
Flo riculture/Aquacultu re Production law.
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery /Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity I' i t r Ll... i o
NC: only DOT and US Government are exempt C'J. •I' 1 t s :.I'b v ul� be I tit c'i j.;1 a
Fertiliser /Agrichemicals 4 sr 't E_i; t fU oir.
Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient or Component Parts (KS) 'c? r O:'d... iji 'i ar d) '(J P1G'. ;t
IlU L t�1
Other: Sl'�..S .tN..d..
C STO E SIGNATURE: (REQUIRED) MGR. APPROVAL
a x
C S
USt AlFIEA ONLY WHENREGISTER IS INOPERATIVE.
ASH: CHECK.' V,ISA. M /C ,DISCOVER TSCCHARGEACCOUNTNO.- CHG, EXCH DATE
NUMBE E, UNIT PR ICE
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY.COMPANY
IU y P.O. Box 9020
Des Moines, IA 50368 -9020 I li 1 ao u
TSC TEAM MEMBER TO COMPLETE Please include 16 Dig Account Number
6035 301
NAME
ADDRESS 11 if'. },ll,•:I
(31 571 ;:1 i1
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE
1100 e i.
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: t
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 0 t,
property as indicated below and/or purchaser is 6. 0 •fi
indicated below and understands engaged in the business of agricultural production of
and agrees with the General 1 �C. C._:r>i t.� 3sj
food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and I :;.r.,
resale and /or uses the farm machinery, equipment or r ,17.6 1
the applicable statement of the {`u 076.;'L�> Y sU .t a
respective state printed on the other agricultural production items purchased free of r;I ah
reverse side of this form. tax, as defined by state law, and as indicated below. (;Fran G
n
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 w I i,
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. -tit'" U
PURCHASER IS ENGAGED IN: (REQUIRED) r
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in 6 CCO 't tncr 4, s 1 A,r nc r,
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) S 1 5 3
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
INC: only DOT and US Government are exempt !Ir•v r ;a+t;l 4e r :I t i F u it
Fertilizer /Ag riche micals Ilt t lit: tl', .t nt: fc f.i6._iYli' iv tltr �r
Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient Component Parts (KS) t I" I J t-' I fi i Ca rii 1 F`tl :i; r',•`_
CII ill ''I !It I I cnsl 7� 7rt
Other:
PTERATURE:(REQUIRED MGR. APPROVAL
X
USE SHADW AREA: ONLY
A H CHECK VISA :M1C DISCOVER TSC CHARGE ACCOUNT NO. k "'CHG EXCH.' DATE
NON
Farm No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMITTSC BUSINESS ACCOUNT PAYMENTS TO:
TRACTOR SUPPLY COMPANY
�YCO
DO Moi A 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
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for s
the applicable statement of the
resale and/or uses the farm machinery, equipment or
t F
respective state printed on the other agricultural production items purchased free of
reverse side of this form. tax, as defined by state law, and as indicated below. r•
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 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) W.
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 be subject to
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production
Floriculture /Aquaculture Production law', d
Other. r„
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity 1
Livestock Injestibles 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:
GUSTOM)SIGNATURE: (REQUIRED) 1!!1 rr1L MMGR.APPROVAL
1 0 A pit•i� .Il,! +.t t }7 it -t
USE St
=A31 CHECK" VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG: EXCH. DATE
e
LJ
1 .ITEM NUMBER
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SU YC® P.O. Box 9020 T,•., r, ;,t,.,
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301
NAME t, :f J (i i. W_ -;J
ADDRESS
(�i ri 5• l :�i
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 e p roperty as indicated below and /or purchaser is r
indicated below and understands p Y p i i .!tr L I. t• s i':; 2,;';
engaged in the business of agricultural production of
and agrees with the General I C•) ;L S;;° tti
f h
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for J I`z`
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
reverse side of this form. tax, as defined by state law, and as indicated below. )v s
The under art further certifies the
PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty Y
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 York 8 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) L U
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 be subject to='
Dairy Production tii il::. J.1" it 'tioj iii I ai'ch'o,r_ n
Livestock Production penalty and /or other provisions as allowed under state
Floriculture /Aquaculture Production law'
Other: nt. Ord,' ILL i(I i;i. (a
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity i,i L
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
Ingredient or Component Parts (KS)
Other:
C (REQUIRED) MGR. APPROVAL
X
e
xnro CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
IfEMNUMBEW DESCRIPTIdN
Form No. 99-00401 (12/05) CUSTOMER ORIGINAL
REMITTS BUSINESS ACCOUNT
)VTBACTOR <PAYMENTS TO:
TRACTOR SUPPLY COMPANY
Su" P.O. Box 9020 ciur ctrl 1: !:qr1 arY
Des Moines, IA 50368 -9020 I is v J j i i in
TSC TEAM MEMBER TO COMPLETE please include 16 Digit Account Number 1! i; LA j 60?
(31 r i lEif' J
6035 301
NAME LCtIi IL i r,;r 1.1 11_F' I
3400 1J 1 'i J s l Sr
ADDRESS Al- I li Ot;
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE rE'0' -I
40. 00 E+ 1 4.90 13r1. V R'r
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 persona)
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 r
food or fiber, horticulture, a uaculture of floriculture for
Exemption Statement at right and q
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 LI�aI1.e t) c1;
reverse side of this form. tax, as defined by state law, and as indicated below. C 1,;1 f .,r_1:
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, d
(REQUIRED) due on the purchase price for the goods as allowed by y flni s I 1 -1 is j t
(Exceptions Georgia, New York Kentucky state law should such goods be used or consumed In
COMPLETE REVERSE SIDE) a taxable manner as defined b state laws.
y 'lit[ ti,::-.r?R.d •'rcP1:+rd;.•�e ,�t�ll 1,, �'n
PURCHASER IS ENGAGED IN: (REQUIRED) ;3(- r U rScl !1!.'I'J'• f; 11! (.,<.tVi:Olt�.:i' 1l _•P.'llL :Ii,
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 be subject to
Dairy Production penalty and/or other provisions as allowed under state
Livestock Production
Floriculture /Acivaculture Production law.
Other:
ITEMS PURCHASED WILL BE USED FOR: (REOUIRED) Fi53k3eu8 3?; "..8L:P$zS8 Y';$ £�E3
Farm Machinery/Repair Parts Government Agency (Entity Ca 11. €200 96L. O7s4 l i. 17th,/ 7 dZir Lt
t(�rh J,rit L•'•1L. r: t r
Livestock Injestibles or Injectibles Exempt Organization (Entity 6e u i1i a
NC: only DOT and US Government are exempt P1 ii; ti Jr11AIr, f Ur L ilr.iiC,. a r; t,
FertilizerlAgrichemicals r':x"0 �L! yr xns •t c
F1 Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient or Component Parts (KS)
Other:
CUSTOMER SIGNATURE: {REQUIRED) MGR. AP AL
USt
if INO PERATIVE
CASH CHECK •VISA M(C ,DISCOVER=' TSC CHARGE ACCOUNT NO. ,CHG. EXCH. DATE
Ll
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAY TO:
TRACTOR SUPPLY COMPANY
C o P.O. Box 9020
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO.COMPLETE Please include 16 Dig Account Number
g
6035 301
NAME CFI (ii ICI_ E;liii.f i a rri
3�C� i31�1 iii
ADDRESS
(Ii} 57 1 '.11:1
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE 111'> ef;) =L =k Pill
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
ned certifies 1 I v6E;1 1
The undersigned
g The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal l;, t 1 t a'
sales tax exemption law of the state property as indicated below and /or purchaser is
indicated below and understands iCl�i;� i'.,' k'T i
and agrees with the General engaged in the business of agricultural production of �3
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for
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 su:,tr ;o i6 4i;
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
p arty y Ct.,l
STATE: understand they may be liable for payment of all taxes t ":cr a Gfl(
(REQUIRED) due on the purchase price for the goods as allowed by
(Exceptions: Georgia New von a Kentucky state law should such goods be used or consumed in'
COMPLETE REVERSE SIDE) a taxable manner as defined b state laws.
y
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
Dairy Prod uction Production of exemption will cause the purchaser to be subject to r o f ;:n�I r rt
E3 Dai Production
C] Livestock Production penalty and /or other provisions as allowed under state
FloriculturelAquaculture Production law. lko d 'C i b d 1•;e; r.l:, i t }i .h•. K,,. i.:
Other: EtCCC.P liih ti,� {;ar.'�o'Jee ;lre�n lt.
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity ai .+0 i ut'r
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
Ingredient or Component Parts (KS)
Other: C!
CUSTOMER SIGNATURE: (R QUIRED} MGR. APPROVAL
�J X
USE SHADED AREA ONLY
GASH ..,CHECK VISA M/C DISCOVER ;TSC CHARGE ACCOUNT NO.',- CHG EXCH. DATE
ITEMNUMBE D ESCRI PTI O N
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
IWTOR PAYMENTS TO:
TRACTOR SUPPLY COMPANY
P.O. Box 9020
U 4:I'i t'!; C�r,I °a•t,
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number i•t� tc ,J, i,i
6035 301
NAME
5;10 i3l,W Vii;
ADDRESS
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies The undersigned party certifies their exemption from (:UI
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
and agrees with the .General engaged in the business of agricultural production of
food or fiber, horticulture, aquaculture of floriculture for I ''''J
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 4.87
reverse side of this form. tax, as defined by state law, and as indicated below. r p 10 11
The under art further certifies the
PRODUCT ISTO BE USED IN THE FOLLOWING 9 p ar t y Y
STATE: understand they may be liable for payment of all taxes i, o
(REQUIRED) due on the purchase price for the goods as allowed by
i lcc,,::1 "..;s .,x:.4'.4;
(Exceptions: Georgia, 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.
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in
F1 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 C0t
Livestock Production
Floriculture /A uacuiture Production law.
4
Other to-, ui d'ut. c I'll iu Co.
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
0 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 1
Ingredient or Component Parts (KS)
Other:
r't I; t
.or: lt. to it Lttvv; .I [1, c t;:,'_d iIt
CUSTOMER SIGNATURE: (REQUIRED) MGR: APPROVAL
Z X
SHADED ARtICONLY WHEN REGISTER IS INOPERATIVE.
-0ASH CHECK p VISA r M!C 7SC CHARGE ACCOUNT Np: CHCi. EXCH. DATE
❑a of to o
P'.' /i }S'F' �.fi: �i y.�.!.JF� :Ir11.1 •'l l�
1 {z r„ V 10•,11 f ;cn1rE J7 `TI.itlrq
Form No. 99-00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
TE PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUI%YCO P.O. Box 9020 I1,ir_ t,JI Surrl.r C( r ;iiiy
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 1,42Lf ,•1 i.U,
6035 301 (il 1 j) b .1 t
NAME
i';0 1 1 V i riT 5T
ADDRESS
(WI) .rI 21 '.1
CITY STATE ZIP PHONE i ;y, 4; ;F}1 :Zi
CUSTOMER TO COMPLETE S u
17. 7e j7
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies
g 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 1', ;YL I iA.
indicated below and understands engaged in the business of agricultural production of
and agrees with the General t .f,% 2 ;2 'IT
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for
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 �;.L.
reverse side of this form. tax, as defined by state law, and as indicated below. 0 V
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they
understand the m be liable for payment of all taxes
STATE: Y may P Y
(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 1 ri'u.r I 1 '9,', l
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws. F i �.,�r)
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 r i tile
Agricultural Production i
of exemption will cause the purchaser to be subject to
Dairy Production penalty and /or other provisions as allowed under state r t I''' "J
Livestock Production law.
F] Floriculture /Aquaculture Production 1. J; I
Other: itC1 01 .11,:1 -I.o 'i it I�C n: -1 C� 111.1 f
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
Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient or Component Parts (KS) t u
Other: bi �;F •r. 's£ b�:;`l'E
4CASHCHECK URE: R I IED) MGR. APPROVAL
X
USE
VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
QUANTITY ITEM NUMBER DESCRIPTION
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
1V TMaCT0K TRACTOR SUPPLY COMPANY
s� YC® 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'i f!'J.f LI_I lit i-0
CITY STATE I ZIP PHONE
CUSTOMER TO "COMPLETE ;v AJ O, LI l ,;J- WY;t'N LR
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies The undersigned party certifies their exemption from 1 d. r.. 11
compliance with the agricultural r I 1
payment of sales and use tax on tangible personal 1
1. t I''t;rr °:i
sales tax exemption law of the state property as indicated below and /or purchaser is t= 1 2
indicated below and understands
and agrees with the General engaged in the business of agricultural production of
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for
resale and /or uses the farm machinery, equipment or
the applicable statement of the other agricultural production items purchased free of l .rte w
respective state printed on the r
i}
p p tax, as defined by state law, and as indicated below. r k'` =1 r11It i 11{-
reverse side of this form.
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they It 1 25
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 York &Kentucky state law should Such goods be used or consumed In I I 1 I• i
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. �wll it lr' A 3 +_STLli:1
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in +J. U., 3
Exempt organization every material manner. A willfully false representation
Dairy Production Agr Production
i of exemption will cause the purchaser to be subject to
Dary Prod =q; g ut E
penalty and /or other provisions as allowed under state ALCi is 7
Livestock Production tit/ tit: l 1 QrJ;3t li, f'; l fit S 5
Floriculture /Aquaculture Production law' I
0 1 02
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) i �l t k
Farm Machinery/Repair Parts Government Agency (Entity
"c!: :Fiut•.us+'S ;I t �r.t.i+ i n•6 rr..
Livestock Injestibles or Injectibles Exempt Organization (Entity Cl
FertilizerlAgrichemicals NC: only DOT and US Government are exempt L1P. D h r,; ;.1� j! h i r 1 a
Consumed in Producti (KS) Res e ales Tax Permit
ke.:
Ingredient or Compon t Parts (KS) ICLL! +!,1_IL a
Other:
USTO ERSIGNA R( OUIRED) MGR. APPROVAL
f X
i
A D ED AREA OMLY WHEM REGISTER IS INOP
CASH
USE SI-I
Li 'CHEC VISA M1C DISCOVER ;TSC CHARGE ACCOUNT NO. CHG EXCH. DATE
oo
n
F ITEM NUMBER D ESCRIPTI O N
TAk
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
1 rg Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�3�tb
Total 5�
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
JUCHER NO. WARRANT NO.
ALLOWED
L4) r IN SUM OF
Anm 1A
ON ACCOUNT OF APPROPRIATION FOR
Board Members
o INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
461 ou A 6 S 7 l 0 I n 6a- I '�D 4 9 bill(s) is (are) true and correct and that the
0 3a 11,6 materials or services itemized thereon for
57 OC 0 �35�IG i� �S b 4 which charge is made were ordered and
43l 8Q 53oi 0 Sb 1a5. received except
100 0 (to
oc ip Zvi c 3� i✓ .g
�I 3 i vv 3o I[,� cc I o 6' 0
C APR 2
20
Signa e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund