HomeMy WebLinkAbout158161 04/01/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
ONE CIVIC SQUARE TRACTOR SUPPLY CO
1 CARMEL, INDIANA 46032 PO BOX 689020 CHECK AMOUNT: $260.38
DES MOINES IA 50368 -9020 CHECK NUMBER: 158161
CHECK DATE: 411/2008
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMO DESCRIPTION
2201 4232100 STREET 94.31 6035301200050860
2201 4237000 STREET 141.27 6035301200050860
2201 4238900 STREET 24.80 6035301200050860
page 1 of 5 T
�o
VS&YC
M
BUSINESS ACCOUNT
0000441
AC'GiJUNT SUMIARY t
6I353 tDQ05 08fit�r
Previous Balance 1,379.86 Closing Date 03/19/08
Payments 629.16 Next Closing Date 04/18/08 CARMEL STREET DEPT
Credits 0.00 Payment Due Date 04/13/08 CINDY
Purchases 260.38 3400 W 131ST ST
Debits 0.00 Current Due 260.38 WESTFIELD, IN 46074 8267
FINANCE CHARGES 0.00 Past Due Amount 750.70 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 1,011.08 Credit Available 4,222
New Balance 1,011.08
CURRENT ACTIVITY
TfiarlSaGtiplT LOC2tI4n/ ffi /1rr10L11t1
ip l a
FEB 19 GOODS AND SERVICES WESTFIELD IN 10.42
FEB 26 GOODS AND SERVICES WESTFIELD IN 8.60
TOTAL 6035301200074803 $19.02
MAR 17 GOODS AND SERVICES WESTFIELD IN 94.31
TOTAL 6035301200074811 $94.31
FEB 22 GOODS AND SERVICES WESTFIELD IN 25.77
MAR 5 GOODS AND SERVICES WESTFIELD IN 13.52
MAR 18 GOODS AND SERVICES WESTFIELD IN 96.48
TOTAL 6035301202895973 $135.77
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL
Subject to Periodic Billing PERCENTAGE Subject a Periodic Billug PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN 0.00 .00000 29 0.00 0.00 .00000 29 0.00
This Account issued by Citibank (South Dakota), N.A. FAX NUMBER 1- Ei01 -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
If you think your billing statement is wrong, or if you need more information is more than 3 months prior to your request. We add this fee to your regular
about a transaction on your billing statement, write to us (on a separate revolve credit plan balance,
sheet) as soon as possible at the billing error address on the front of your
statement. We must hear from you in writing no later than 60 days after we Payment Options Other Than Regular (Wail:
sent you the first statement on which the error or problem appeared. In your
letter, give us the following information: Pay by Phone. You may make your payment by phone by using the Pay by
PhG c 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. o Send payment by courier or express mail to the Express Payments
address: Customer Service Center, Dept. CCS 8725 W. Sahara Blvd., Las
Important Payment Instructions Vegas, NV 89117. Payment must be received in proper form, at the proper
address, by 5 p.m. Pacific time in order to be credited as of that day. All
Crediting Payments: Payment must be received in proper form at our payments received in proper form, at the proper address, after that time
processing facility by 5 p.m, local time there to be credited as of that day. A will be credited as of the next day.
payment received at the processing facility in proper form after that time will
be credited as of the next day. Please allow 5 -7 days for payments by Report a Lost or Stolen Card Immediately: Customer Service is available
regular mail to reach us. There may be a delay of up to 5 days in crediting a 24 hours a day, 7 days a week.
payment sent by mail if it is not in proper form or is addressed to a location
other than the address listed on the return envelope or on the front of the Your account is issued by Citibank (South Dakota), N.A.
payment coupon, or, for courier or express mail payments, to the Express
Payments Address set forth below.
Proper Form: For a payment sent by mail or courier to be in proper form,
you must:
Enclose a valid check or money order. No cash, gift cards, or foreign
currency please.
Include your name and account number on the front of your check or
money order,
Tractor Supply Co. Full Balance S902TV 10/06
902TV5741006 PCT
r N
page 2 of 5 T
rsumyc
BUSINESS ACCOUNT
0000442
=°S
CURRENT ACTIVITY
Transactions LccatioN
tltnount k
Rate pescrptron
n EL
MAR 18 GOODS AND SERVICES NOBLESVILLE IN 11.28
TOTAL 6035301202896054 $11.28
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
FEB 21 PAYMENT REF P919400E409NP6N7B 629.16
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 3 of 5 257
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860�R
DEPT.30 1200050860 JEFF STEWART VSUMYCO-
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000443
Payment Due Date: 04/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
s
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000816050010 431000815996010
Purchase Order:
TRUCK57
AMOUNT DUE: 265.77 AMOUNT DUE: 52.98
Store: 574000431 INVOICE DATE: 02/05 /08 Store: 574000431 INVOICE DATE: 02/05 /08
3IN1 RATCHET 19PC M ET 4036320 1.00 9.99 9.99 FUEL NO22LE AUTOM UNLEA 3958236 1.00 52.98 52.98
HAMMER SIB FG CROSSPEEN 4000565 1.00 16.74 16.74
T POST OFT 1.25LB 3609146 48.00 4.98 239.04 SUBTOTAL 52.98
TAX 0.00
SUBTOTAL 265.77 SHIPPING 0.00
TAX 0.00
SHIPPING 0.00 TOTAL 52.98
TOTAL 265.77
SHIP TO: INVOICE: SHIP To: INVOICE:
431000818518010 431000818762010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 30.36 AMOUNT DUE: 10.42
Store: 574000431 INVOICE DATE: 02/18 /08 Store: 574000431 INVOICE DATE: 02/19 /08
ND40 GALLON 0134312 1.00 12.38 12.38 GB GALV AND COTTERPIN B 3568887 4.20 2.40 10.42
PB PENETRATING CATALYST 7036044 1.00 17.98 17.98
SUBTOTAL 10.42
SUBTOTAL 30.36 TAX 0.00
TAX' 0.00 SHIPPING 0 .00
SHIPPING 0.00
TOTAL 10.42
TOTAL 30.36
1
b
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
258
Remit To: Bill To- Page 4 of s
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 60353012000508608
DEPT.30 ,1200050860 JEFF STEWART ®SUMYC2
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000444
Payment Due Date: 04/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000820080010 431000816207010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 8.60 AMOUNT DUE: 102.52
Store: 574000431 INVOICE DATE: 02126 /08 Store: 574DD0431 INVOICE DATE: 02106 /08
62 BULK SELLING SKU 3599993 7.05 1.22 8.60 CASTER 61N RIGID STEEL 3598094 1.00 24.02 24.82
CASTER 61N RIGID STEEL 3598094 1.00 24,02 24.82
SUBTOTAL 8.60 CASTER 61N SWIVEL STEEL 3592014 1.04) 26.44 26.44
TAX 0.00 CASTER 61N SWIVEL STEEL 3592014 1.00 26.44 26,44
SHIPPING 0.00
SUBTOTAL 102.52
TOTAL 8.60 TAX 0.00
SHIPPING 0.00
TOTAL 102.52
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000824397010 431000819251010
Purchase Order: Purchase Order:
SHOP 22208
AMOUNT DUE: 94.31 AMOUNT DUE: 25.77
Store: 574000431 INVOICE DATE: 03/17 /08 Store: 574000431 INVOICE DATE: 02122 108
HOBART HELMET 10 FLIP 3807299 1.00 32.36 32.36 CAP QUICK CONEJET BLUE 2101420 1.00 8.59 8.59
HOSE 1121NXSQFT AIR PRE 3990393 1.00 30.76 30.76 CAP QUICK CONEJET BLUE 2101420 1.00 8.59 8.59
WELLER SOLDER GUN KIT 3800108 1.00 31.19 31 -19 CAP QUICK CONEJET BLUE 2101420 1.00 8.59 8.59
SUBTOTAL 94.51 SUBTOTAL 25 77
TAX 0.00 TAR 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 94.31 TOTAL 25.77
Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425
259
Remit To: Bill To: page 5 or 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860C�
DEPT.30 1200050860 BRAD HENDERSON ®Su+Yc
PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000445
Payment Due Date: 04/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000821760010 431000824592010
Purchase Order: Purchase Order:
30508 21808
AMOUNT DUE: 13.52 AMOUNT DUE: 96.48
Store: 574000431 INVOICE DATE: 03/05/08 Stare: 574000431 INVOICE DATE: 03/18 /08
HOSE 3 /BX10FT SPRAYER E 2112667 1.00 7.92 7.92 INSERT TEE 11/2 11/2 11 2109143 1.00 3.39 3.39
CLAMP STAINLESS 3/8- 5/ 3181172 10.00 0.56 5.60 CLAMP STAINLESS 1 1 /4TO 2107769 7 -00 0.99 6.93
ADAPTER MALE TPT HB 1 1 2108901 3.00 2.89 8.67
SUBTOTAL 13.52 BALL VALVE 1 1 /2IN BOLT 2107549 1.00 22.86 22.86
TAX 0.00 BALL VALVE 2IN BOLTED 2107557 1.00 33.98 55.98
SHIPPING 0.00 QUICK COUPLER 2IN PART 2121666 1.00 5.98 5.98
REDUCER BUSHING 2X11/2 2109224 1.00 3.69 3.69
TOTAL 13.52 QUICK COUPLER 21H PART 2121658 1.00 10.98 10.90
SUBTOTAL 96.48
TAN 0.00
SHIPPING 0.00
TOTAL 96.48
SHIP TO: INVOICE:
624000931813010
Purchase Order:
31808
AMOUNT DUE: 11.28
Stare: 574000624 INVOICE DATE: 03/18 /08
TAPE TEFLON 112X2601N 3149926 1.00 1 -30 1.30
QUICK COUPLER 2IN DUST 2121705 1.00 9.98 9.98
SUBTOTAL 11.28
TAX 0.00
SHIPPING 0.00
TOTAL 11.28
Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425
REMIT TSC (BUSINESS ACCOUNT
-RACTOR PAYMENTS TO:
W TRACTOR SUPPLY COMPANY
S ry 0 P.O. Box 9020
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE LI 5 at 1!c cn
Please include 16 Digit Account Number (J:2 i t iC Jd, i.r. �1G01 b
6035 301 t'3 i 7) 43L 5
NAME
s tr7 ;1 13 i siT I
ADDRESS F;
1.•llJ �4t 'l•
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE .G 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 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 l 1h• ^t
and agrees with the General
Exem tion Statement at ri ht and food or fiber, horticulture, aquaculture of floriculture for
10,
p g resale and /or uses the farm machinery, equipment or L t'' A'
the" applicable statement of the other agricultural production items purchased free of 'ttiit::D ;19t331?4i;5
respective state printed on the tax, as defined by state law, and as indicated below. f'g `'f lot
reverse side of this form. f'1tn,IS 0,
PRODUCT ISTO BE USED INTHE FOLLOWING The undersigned party further certifies they Cd.sit fi;ach
STATE: understand they may be liable for payment of all taxes
(REQUIRED) due on the purchase price for the goods as allowed by o1c co-1.1i:
(Exceptions: Georgia, New York Kentucky State law should such oods be used or consumed d in
COMPLETE REVERSE SIDE) g kC ✓'y 1 115 Sc7).!' 1, ii' i' d Fttt:`
a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the 1;1 rto: "0 !)I
Government information on this statement is true and correct in iiccert rt', -r itl, Vic C'rdnrrlJVT' I >3t'reL,tr:
Exempt organization every material manner. A willfully false representation
Agricultural.Production of exemption will cause the purchaser to be subject to
Dairy Production
E) Livestock Production penalty and /or other provisions as allowed under state k,i51-1 i L
Floriculture /Aquaculture Production law'
Other.
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery /Repair Parts Government Agency (Entity
Livestock lnjestibles or lnjectibles Exempt Organization (Entity C-,l 1. fiR'7 r$13'r o thj.tt 7 ut, r3 to
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Cal 7 ,sir vt% t;t,t; t r t c erJ i n :a
Consumed in Production (KS) Resale (Sales Tax Permit ',11Jt1; h1 V' L-11' :'4i n� f 0V a. C:NtlttLLI fil ttr' i{ A
Ingredient or Component Parts (KS) :A'. '_d a', Gi'f: :!t� PI!:'i(''i1 l:
Other: 1:?.. t i! t�'F_55(,� Crds 9
C T R GNATURE: (REQUIRED) e� MGR. APPROVAL
X
_QA CHECK vlsA M /C DISCOVER TSC'CHARGE ACCOUNT 'NO.,; CHG. EXCH DATE
Form No. e9 00401(12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
S P.O. Box 9020
Sur'o- t., IJo i :tn.
Des Moines, IA 50368 -9020 7tyt6t� ;I,:,. tfr, *t•;1
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number t -'u Y l--! t 07�;
6035 301 (31 6"1
NAME
I.t 1: ST q
ADDRESS
;�•1rl 571- 7141
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE
7,0'1 L' 1, 2 f,GO P:1
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: uuver uren'? i? ^eitCi.Ea
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal `wttl,iUt+
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 IG'i'•,i t
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 ''0 76020 1& Gi2ff)g411067
respective state printed on the tax, as defined by state law, and as indicated below. PO
reverse side of this form. CrL,n1 rie 0100
PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they Ca•:,;,
STATE: understand they may be liable for payment of all taxes
{REQUIRED) due on the purchase price for the goods as allowed by ui o cuor ie
(Exceptions: Georgia, New York Kentucky state REVERSE SIDE) State law Sf10Uld SUCK goods be used Or consu I n
a taxable manner as defined by state laws. cii, Q; t)1! e l tl
lir and I liiri :i G
PURCHASER IS ENGAGED IN: (REQUIRED) r
Resale Under penalty of perjury, signee swears the i;rc dc s; r ;t drf I,:,, ,i i,c ?',c .I .11.1 t„': 0
Government information on this statement is true and correct in
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to
Dairy Production I
F Livestock Production penalty and/or other provisions as allowed under state
Floriculture /Aquaculture Production law'
F1 Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity ti
Livestock Injestibles or Injectibles Exempt Organization (Entity tt 1 C,1 1300 96' 07'S of 1 41).11 7 J,o
Fertilize r /Ag rich emicals NC: only DOT and US Government are exempt o-101,; i;: s_;IP4,. it i. ho g`u't rCd i';i a
+an
Consumed in Production (KS) Resale (sales Tax Permit (hf.r 0 rac �.in5 r b cfltr.CP tQ 45.11 t i
Ingredient or Component Parts (KS) t Ciwd) i'1 r U NW,`
Other: r;t�
CUSTOMER SIGNATURE: (REQUIRED) MGR APP OVAL
X �I
A6 ejAREA01NILMHERREGISTERIS INOPERATIVE.'
CASH CHECK, VISA u MIC DISCOVER 5 G ARGE ACCOUNT NO:. CHG. ,EXGH. DATE h
DESCRIPTION
Form No. 9e -00401 (12/05) CUSTOMER ORIGINAL
tl YEMIT.TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUNLY P.O. Box 9020 Tri, 1, ?,,il .J:a Pitt 147:
Des Moines, IA 50368 -9020 M160 1710 o r :t+ i •,t ri,
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number dk� :,tI J "le"
6035 301#
NAME
M!4 131;'rSr
ADDRESS Ul 'i•: 1 i1� 6 1(' ,!{�t
CITY STATE ZIP PHONE
i •f:1t Ort�t ,'tJ c h��, l
02, 0 :071t;
:g7aft
CUSTOMER TO COMPLETE Zin.1VO El OUIC;, C11 8L
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT 1, (10 a.p qtr
T:
lnurar•;tr n I'1�71_rsr:i
The undersigned certifies The undersigned party certifies their exemption from :'101't24 ct�r 0
compliance with the agricultural payment of sales and use tax on tangible personal t 0� r 0,55 x. PIT
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 %il71 -fir' FlUICIN CGt.' I T
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for t )J r' f3,: -S' 0 .59 111
Exemption Statement at right and resale and /or uses the farm machinery, equipment or"` ulr�rlt f;ct_ n1_:eE's
the applicable statement of the other agricultural production items purchased free of
respective state printed on the riv61o,i:;1 25.77
reverse side of this form. tax, as defined by state law, and as indicated below.
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they l otcl. ?5.77
understand the may be liable for payment of all taxes i Si- caec
(REQUIRED) 9,:.
srarE: due on the purchase price for the goods as allowed by `Wc t 1 a r; s °'1
Exceptions: Georgia, New York B Kentucky state law should such goods be used or consumed in Ou i,)v' 02
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. r Q ?2. 7 00
PURCHASER IS ENGAGED IN: (REQUIRED) Ci t 'ISC 0, 0.)
Resale Under penalty of perjury, signee swears the ce.,h P. -Ick
Government information on this statement is true and correct in
Exempt organization every material manner. A willfully false representation the 1•cce:�r of a cnpwk
Agricultural Production of exemption will cause the purchaser to be subject to: a
Dairy Production and /or other provisions as allowed under state 1:01 Of tni =.t; t;, :,Ix:' �trld t1, I ul ch >tae a
Livestock Production
Floriculture /Aquaculture Production law'
tit: d4:;l:r 7k u�; citt Idj.;n ;halal �,e? iI?
Other: �Cr „yrt ;'2.t ai i'i1 ti, C: is i ClUc.i t1src :_ate, ^,4',
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
1ltr
Livestock Injestibles or Injectibles Exempt Organization (Entity 1
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit 1
Ingredient or Component Parts (KS) v 3 3 8 'd 31, I> s '1 x 8 a s l' 3 J, 3 8y 3
0 Zy fl:e�igt>'s5° 2.D 3I i S fi$t:3 SSSSfi
Other
to
col r Jeff• i. •;�rr,•r �1rJ e}ti'f:rt:c1 ;ti a
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
f X
USE J o ONLY e•
CASH CHECK .°`VISA 'S M /G; DISCOVER TSC CHARGE ACCOUNT NO, CHG. EXCH. DATE.
")ri1' 2.•.l' .'t.1,111r 102x1 ?.t�fi.
is: ?f ;i.5,4_ t$i.•.. cSt is R.E�2
:Tty.'4)�1.' C'111 7 .'11.' •`1 i i 1
�7 1T J r,P,.`.:._c...'.,r
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
11 PAYMENTS TO:
NO TBUT0TRACTOR*SUPPLY COMPANY
UPPLYC2 P.O. Box 9020 1 1" i v, "*LW 1 1',
Des Moines, IA 50368 -9020 101 t!, 1. 31 Nor ch
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301 (31 05?-
NAME
3400 G• 131 5 r
ADDRESS I!CS1F'.,ELD TA tGQr E326c
l�17) 5h' %fii
CITY STATE I ZIP PHONE
I :,`111.1
CUSTOMER TO COMPLETE
1 ryr C 3� s 32. iG OT OF EXEMPTION: GENERAL EXEMPTION STATEMENT: I_ t r,,,,,,, ��r,t:.i
The undersigned certifies The undersigned party certifies their exemption from i ?zg3 F� 1F 1 i2 i:;'' 7 At
compliance with the agricultural payment of sales and use tax on tangible personal 1'40 r :70, =U. %'l1
sales tax exemption law of the state property as indicated. below and/or purchaser is Ga4,'1 n ,l n i
engaged in the business of agricultural production of
indicated below and understands SHU1013 !;ELI CR CIA Ili
and. agrees with the General j CQ i .17 31 .15 t;T
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 e
respective state printed on the tax, as defined by state law, and as indicated below: `rbwi'`T N Si
reverse side of this form. b. rTO: Ta' 0. Oki
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they L %'.r
understand the may be liable for p ayment of all taxes I1 C 31
STATE: Y Y p Y q_
(REQUIRED) due on the purchase price for the goods as allowed by r,c.L t�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.
PURCHASER IS ENGAGED IN: (REQUIRED) 0. 03
I; e R t
CJ Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in 111.'_1 ac no, t.If�t '41.0 recce :1 L'Uftl'l
Exempt organization every .material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject t'o�
Dairy Producti LtA'Y l3i th.i� z7r35 rA P i,:Li il.c r e[CI`a5U
E] Livestock and /or other provisions as allowed under state
Livestock Production
Floriculture /Acluaculture Production law' 'ho dcuL Lc.1 i.Itl +_?1 ..ttdi, e }t;�T L,: 1 t
Other r: If;n {.E' /.,.iii ih:' C rrl c, :r:cI
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
Ferlilizer /Agrichemicals INC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit 1
Ingredient or Component Parts (KS)
Other: 1
LO. to t ,1 Ii1 v 1'N,
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
X
EAONLY WHEN REGISTER IS INOPERATIVE.
IUSE AN
CASH CHECK VISA MlC, DISCOVER TSC CHARGE ACCOUNT n€O: CHG. EXCH. DATE
UNITPRICE
ITEM NUMBER
r
Form No. 99 -00401 (12!05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS T0:
TRACTOR SUPPLY COMPANY
5Uyr® P.O. Box 9020
Des Moines, IA 50368 -9020 I
1 lor
1f?16p L.S. �;'I dt�rt),
TSC TEAM MEMBER TO COMPLETE please include 16 Digit Account Number l.: i 1'd 1'eoi -i
6035 301# (:317) M7 3505
NAME
5li�r+I I P7
3.100 I; 1AIST S
ADDRESS 1!:.5i1' RD If: JI,0 °4`26e
(W) '-e1 714i
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE 21 i f'i'V 110;,7
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: I Go;c
The undersigned certifies The undersigned party certifies their exemption from 31 tf i I i CI.Aii[' S
compliance with the agricultural 1 C+, 0 F
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 g p u'ulsiut r
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for 00'/ t
resale and/or uses the farm machinery, equipment or
the applicable statement of the 7ut(:.:t t3,5?
respective d on the other agricultural production items purchased free of
res p p printed
tax, as defined by state law, and as indicated below. t•3 (.iL
reverse si state
of this form. r, kSr'� "f
The under art further certifies th f t t `'00532i',, l: c`'t "2Zr
PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty
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
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. t
PURCHASER IS ENGAGED IN; (REQUIRED)
lA�C•,' iSGltlirld r iii,_ 1'f_•i:! ?Ii UY' i:rJl:,'iC
Resale Under penalty of perjury, signee swears the'
Government information on this statement is true and correct in oi LF t,-Aes �,lil
Exempt organization every material manner. A willfully false representation
Agricultural Production i(t; Je, rztc[:r t „4l�:lt r +di_,a ;aat C; i.h
of exemption will cause the purchaser to be subject to
Dairy Production penalty and /or other provisions as allowed under state u IJ 91
Livestock Production
Floriculture /Aquaculture Production law'
Other: `:iJootn.re.
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Mach inery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injestibles Exempt Organization (Entity
Fertilizer /Agrichemicals INC: only DOT and US Government are exempt
Consumed in Production KS Resale (Sales Tax Permit lo
Ingredient or Component Parts (KS) Cui h Ie irL I% !+r V1.r a! d O e c'a 6 J i it et
u +,SIt1 dr�ir,ns u:' c; cil�rr:� iv �t;r:
Other.
r,. {.'•I 8 ii; t i 1i 1e) h; i I'�I`,`('ii:�
CUSTOMER SIGNATURE: REQUIRED) MGR. APPROVAL
r A
USE SHA DED AREA ONLY
CASH CHECK VISA M/C DISCOVER, TSC CHARGE ACCOUNT NQ. CHG. `A EXCH.; DATE
r
i
D ESCRIPTION-
ITEM,,
YNIT PRICE
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
I V SU"LY C® P.O. Box 9020
Des Moines, IA 50368 -9020 Fr��'-' �l +I' l St z 31 Lost 1
TSC TEAM MEMBER TO COMPLETE 4
Please include 16 Digit Account Number r���t,_:;�� t i r tt •}ItUE11..
6035 301# t t 7 Y rG- i t?s3
NAME
5409 Irt i.iE`;f r,l
ADDRESS 1i;.S1l'Ii:ttl tiv `}t5Q /Efiil,!
CITY STATE ZIP PHONE
6,1 621 10(11){ i 1
CUSTOMER TO COMPLETE 611s'YZ6 TAPE ifA -Lt)u 1/2X2601-
CERTIFICATE OF EXEMPTION: GENERAL. EXEMPTION STATEMENT: I "U() EiDVP I t 1
rntt�ni• A3
The undersigned certifies The undersigned party certifies their exemption from rf a:1 ?US OUIU" ClrOPLk.,t 11 d Lt1
compliance with the agricultural payment of sales and use tax on tangible personal 1.0 0 9, 9C 9f' 9f
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 I I .'[U
respective state printed on the tax, as defined by state law, and as indicated below. TSC f :ard 0 ,28
reverse side of this form. frLC r;zky 3
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Authi" 1 01 0199 Re 1 fSO9 {,S i 492
STATE: understand they may be liable for payment of all taxes Pu t: Us1 gUh
(REQUIRED) due on the purchase price for the goods as allowed by Cf:Ewns 0 .00
(Exceptions: Geor 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) ?llt`<' aCltccic.)lt (3`_IE;:, iN l ell''t of :a C('t:1P.'.0
Resale Under penalty of perjury, signee swears the'
Government information on this statement is true and correct in col i of }11.i.l, �3t-ale., :111I ar h I a :hA, ie ra
Exempt organization every material manner. A willfully false representation
Agricultural Production (f1� Iie5cr117eiS +erChE?iuSs r Sik'..t!
of exemption will cause the purchaser to be subject to bt: I:t
Dairy Production penalty and /or other provisions as allowed under state U- LOI`=kkill c: lA th „tj cardholder
Livestock Production
Flo riculture /Aquaculture Production law'
Other: Sisf o it1rC
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(SalesTaxPermit# 0 831Jgna ?:3;87 Rsrrs.i:t::is36g,:
Consumed id Production (KS} tS
8004fd -0Ti', withie 7 L +:;r', to
Ingredient or Component Parts (KS) anl� tv to a t ll Y al:rt he t it Yul c r1 i n ,1
r o1�t11' d :u? r 3 tvr a t honLe to uir. a
Other:
;ta!ri !,prek.!,
((urrr;:J airs 61 (4 C "+rd) „f+ PU`RICI(I'"F
CUSTOMER SIGNATU :(RE D) MGR, APPROVAL
CASH CHECK. VISA MIC DISCOVER` TSC CHARGE ACCOUNT NO. CHG, EXCH DATE
FA L3 U
ITEM NUAI e
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
7-W T011 PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUP lLYC® P.O. Box 9020 T.
Des Moines, IA 50368 -9020 I h
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301
NAME Lrl t. S
SFio 1: 131
ADDRESS
CITY STATE ZIP PHONE ;1
CUSTOMER TO COMPLETE
CERTIFICATE OF EXEMPTION:. GENERAL EXEMPTION STATEMENT:
The u ndersi ned 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 I Il;. •::r #'1 •L11
indicated below and understands
p roperty as indicated below and /or purchaser is 7i�, lj t):r°.
engaged in the business of agricultural production of
and agrees with the General 4. G7
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for tle. n h..U+ c
the applicable statement of the resale and /or uses the farm machinery, equipment or 'i :t5 ..U_ W/ _',L: 1 tr;_I:N
respective state printed on the other agricultural production items purchased free of 00.
reverse side of this form. tax, as defined by state law, and as indicated below.
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they l 35.71
STATE: understand they may be liable for payment of all taxes r
(REQUIRED) due on the purchase price for the goods as allowed by 'iF. (1UiL 1 1 1 !'f'LLT: 2Y;1 P;i
(Exceptions: Georgia' New York a Ke ntucky state law should such oods be used or consumed in
COMPLETE REVERSE SIDE) g I .0" r
a taxable manner as defined by state laws. r
PURCHASER IS ENGAGED IN: (REQUIRED) n t fl tir f',. T )yl l' I;r� i i
Resale Under penalty of perjury, signee swears the I C) 4, 3.
Government information on this statement is true and correct in 'u; li;': ,,c:r�
Exempt organization every material manner. A willfully false representation
E] Agricultural Production
Dairy Production
of exemption will cause the purchaser to be subject to
penalty and /or other provisions as allowed under state
F1 Livestock Production p y p .bc'r ut f1= ,�n1.;..
Floriculture /Acivaculture Production law.
Other:
St;tJ'r�i i6
6,011 T; u,!!;,
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts ,r) .lo .i ❑r-Gover.nment Agency (Entity#
Livestock Injesti6les orllnjectibles� Exempt Organization (Entity t f r y
i.r.',_ .J 4 1 E;' ",NC: only DOT and US Government are exempt
Fertilizer /Agrichemicals
L Consumeci.in,. Production. (KS)<,c 3 >f�L�R i1
esale,(SalesTaxPermit# ;(I, pl
IV")
�Ingredient'o'r Component Parts (ks)
f„'•. I t.r.;ri} :u /!:,Qt••.[,I.t r le.lj
OtheC ti� h t iJ' rR. ul... nl, _i._ .'lf J.
if 'r 'J, 11'r. i.. ?l•,i "t i',' 1'i! 11 j
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL i
2 2 /�l _�C✓� _X
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
QUANTITY ITEM NUMBER DESCRIPTIO
Form No. ee 00401 (1 ?/05) CUSTOMER ORIGINAL
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
I vaC�Ur 6(k_njo i, Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
In oi- n.,o 1A 5 o-* b q Q P
ON ACCOUNT OF APPROPRIATION FOR
t�t l� s
6 0�5 �6 l�--r Board Members
INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1 l o w i 0 f c), d ,)j bill(s) is (are) true and correct and that the
4 31 6co 1 668 no l 0 -t t 0 'e, Lo C materials or services itemized thereon for
461 a� 3 Q 0 I e 1 3 1 which charge is made were ordered and
4,�l 0oU 0 received except
,laI'✓ oo 4Q 3 I sa
UAo 1 i 'Do t 0
MAR 20
Sig `tu�re
J �r C0 n-, rrLu��uTYi C
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund