HomeMy WebLinkAbout157263 03/05/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
F ONE CIVIC SQUARE TRACTOR SUPPLY CO
•II CHECK AMOUNT: $8$0.70
s� CARMEL, INDIANA 46032 Po eox 6e9020
.aa DES MOINES IA 50368 -9020 CHECK NUMBER: 157263
CHECK DATE: 3I5I2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 42.37000 STREET 760.38 6035301200050860
2201 4238900 STREET 30.36 6035301200050860
2201 4356001 STREET 89.96 6035301200050860
I
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page 1 of 5 T
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BUSINESS ACCOUNT
0000411
AC,ggwrI K �UAMMAR�f 6035 3012 UQ05 860 6�......W r.
Previous Balance 1,846.98 Closing Date 02/19/08
Payments 1,347.82 Next Closing Date 03/19/08 CARMEL STREET DEPT
Credits 52.98 Payment Due Date 03/15/08 CINDY
Purchases 933.68 3400 W 131ST ST
Debits 0.00 Current Due $80.70 WESTFIELD, IN 46074 -8267
FINANCE CHARGES 0.00 Past Due Amount 499.16 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 1,379,86 Credit Available 3,860
New Balance 1,379,86
CURRENT ACTIVITY
Trensactlon o a tra L4cattonl Amoun#
!Date ISGrI(# #ton rr
JAN 28 GOODS AND SERVICES WESTFIELD IN 1.29
JAN 31 GOODS AND SERVICES WESTFIELD IN 52.98
FEB 5 GOODS AND SERVICES WESTFIELD IN CREDIT 52.98
FEB 5 GOODS AND SERVICES WESTFIELD IN 265.77
FEB 18 GOODS AND SERVICES WESTFIELD IN 30.36
TOTAL 6035301200074803 $297.42
FEB 6 GOODS AND SERVICES WESTFIELD IN 102.52
TOTAL 6035301200074811 $102.52
FEB 6 GOODS AND SERVICES WESTFIELD IN 60.96
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daily Days in ANNUAL Balance Daly Days in ANNUAL
Subject to Periodic Billing PERCENTAGE Subject to Periodic Billing PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN V 00 .00000 29 0.00 0.00 .00000 33 0.00
This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1-800-559-8232 FAX NUMBER 1-801-775 -7425
f
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 Mail:
sent you the first statement on which the error or problem appeared. In your
letter, give us the following information: Pay by Phone. You may make your payment by phone by using the Pay by
Phone Service. You will be charged $14.95 to use this payment service.
Your name and account number. Call by 5 p.m. Eastern time to have your payment credited as of that day.
The dollar amount of the suspected error. If you call after that time, your payment will be credited as of the next day.
Describe the error and explain, if you can, why you believe there is an We may process your payment electronically upon verification of your
error. If you need more information, describe the item you are unsure identity.
about. Send payment by courier or express mail to the Express Payments
address: Customer Service Center, Dept. CCS 8725 W. Sahara Blvd., Las
Important Payment Instructions Vegas, NV 89117. Payment must be received in proper form, at the proper
address, by 5 p.m. Pacific time in order to be credited as of that day. All
Crediting Payments: Payment must be received in proper form at our payments received in proper form, at the proper address, after that time
processing facility by 5 p.m, local time there to be credited as of that day. A will be credited as of the next day.
payment received at the processing facility in proper form after that time will
be credited as of the next day. Please allow 5 -7 days for payments by Report a Lost or Stolen Card Immediately: Customer Service is available
regular mail to reach us. There may be a delay of up to 5 days in crediting a 24 hours a day, 7 days a week.
payment sent by mail if it is not in proper form or is addressed to a location
other than the address listed on the return envelope or on the front of the Your account is issued by Citibank (South Dakota), N.A.
payment coupon, or, for courier or express mail payments, to the Express
Payments Address set forth below.
Proper Form: For a payment sent by mail or courier to be in proper form,
you must:
Enclose a valid check or money order. No cash, gift cards, or foreign
currency please.
Include your name and account number on the front of your check or
money order.
Tractor Supply Co. Full Balance S902TV 10106
9027 PCT
page 2 of 5 T
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BUSINESS ACCOUNT
�n
0000412
CURRENT ACTIVITY
FEB 8 GOODS AND SERVICES WESTFIELD IN 208.00
TOTAL 6035301200074837 $268.96
FEB 13 GOODS AND SERVICES NOBLESVILLE IN 89.96
TOTAL 6035301202896013 $89.96
JAN 22 GOODS AND SERVICES WESTFIELD IN 121.84
TOTAL 6035301202896161 $121.84
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
JAN 26 PAYMENT REF P919400DB09N4AE13 1,347.82
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!
[�y
Remit To: Bill To: page 3 or 5
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860
DEPT.30 1200050860 JEFF STEWART
PO bOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 000 o413
Payment Due Date: 03/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TD: INVOICE: SHIP TO: INVOICE:
431000810390010 431000810326010
Purchase Order: Purchase Order:
TRUCK2 SHOP
AMOUNT DUE: 388.92 AMOUNT DUE: 116.31
Store: 574000431 INVOICE DATE: 01/10/08 Store: 574000431 INVOICE DATE: 01/10108
BED MAT 8FT FORD 250 35 0184901 1.00 59.48 59.48 LIGHT TRAPEZOID 4X6 HAL 0283917 1 -00 15.59 15.59
TRKBX ALUM SGL FS DEEP 1091703 1.00 329.44 329.44 CASTER 8IN HD TPR SWIVE 5500461 1.00 25.68 25.68
CASTER BIN HD TPR RG11 5500479 1.00 24.68 24.68
SUBTOTAL 388.92 CASTER BI.N HD TPR SWIVE 5500461 1.00 25.68 25.68
TAX 0.00 CASTER BIN HD TPR RGD 5500479 1.00 24.68 24.68
SHIPPING 0.00
SUBTOTAL 116.31
TOTAL 388.92 TAN 0.00
SHIPPING 0.00
TOTAL 116.31
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000814387010 431000815205010
Purchase Order: Purchase Order:
12808 SHOP
AMOUNT DUE: 1.29 AMOUNT DUE: 52.98
Store: 574000431 INVOICE DATE: 01128/08 Store: 574000431 INVOICE DATE: 01/31 /08
REDUCER BUSHING 1/2X3/8 2109169 1.00 1.29 1.29 FUEL NOZZLE AUTOM UNLEA 3958236 1.00 52.98 52.98
SUBTOTAL 1.29 SUBTOTAL 52.98
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 1.29 TOTAL 52.98
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425
Remit To: Bill To: page 4 of 5 zau
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 S+Y� l
DEPT.30 1200050860 JEFF STEWART
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000414
Payment Due Date: 03/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
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 W ET 4036320 1.00 9.99 9.99 FUEL NOZZLE AUTOM UNLEA 3958236 1.00 52.98 52.98
HAMMER 31B 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 431000816207010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 30.36 AMOUNT DUE: 102.52
Store: 574000431 INVOICE DATE: 02/18 /08 Store: 574000431 INVOICE DATE: 02/06 /08
WD40 GALLON 0134312 1.00 12.38 12.38 CASTER 6IN RIGID STEEL 3598094 1.00 24.82 24.82
PB PENETRATING CATALYST 7036044 1.00 17.98 17.98 CASTER 6IN RIGID STEEL 3598094 1.00 24.82 24.82
CASTER 6IN SWIVEL STEEL 3592014 1.00 26.44 26.44
SUBTOTAL 30.36 CASTER 6IN SWIVEL STEEL 3592014 1.00 26.44 26.44
TAX 0.00
SHIPPING 0.00 SUBTOTAL 102.52
TAX 0.00
TOTAL 30.36 SHIPPING 0.00
TOTAL 102.52
Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 -779 -7425
Remit To: Bill To: Page s or s zap
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 w CM
DEPT.30 1200050860 ERIC RUSSELL
PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000415
Payment Due Date: 03/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP To: INVOICE: SHIP TO: INVOICE:
431000816136010 431000816610010
Purchase Order: Purchase Order:
BIKERACKS BIKERACKS
AMOUNT DUE: 60.96 AMOUNT DUE: 208.00
Store: 574000431 INVOICE DATE: 02/06 /08 Store: 574000431 INVOICE DATE: 02/08 /08
FASTENER PROJECT 8.48 3667990 1.00 8.48 8.48 FASTENER TIP BIN 2.08 3771993 00.00 2.08 208.00
FASTENER PROJECT 8.48 3667990 1.00 8.48 8.48
CHAIN STRAIGHT LINK 2 0 3592111 40.00 1.10 44.00 SUBTOTAL 208.00
TAX 0.00
SUBTOTAL 60.96 SHIPPING 0.00
TAX 0.00
SHIPPING 0.00 TOTAL 208.00
TOTAL 60.96
SHIP TO: INVOICE: SHIP TO: INVOICE:
624000918013010 431000813068010
Purchase Order: Purchase Order:
2 12208
AMOUNT DUE: 89.96 AMOUNT DUE: 121.84
Store: 574000624 INVOICE DATE: 02/13 /08 Store: 574000431 INVOICE DATE: 01/22 /08
BOOT STOE BIN CES LTHR 7218735 1.00 89.96 89.96 LIGHT TRAPEZOID 4X6 HAL 0283917 4.00 15.59 62.36
BED MAT 8FT 1999 CHEV G 0184985 1.00 59.48 59.48
SUBTOTAL 89.96
TAX 0.00 SUBTOTAL 121.84
SHIPPING 0.00 TAX 0.00
SHIPPING 0.00
TOTAL 89.96
TOTAL 121.84
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUI%YCO P.O. Box 9020 rra�c Suvply Euuipitav
Des Moines, IA 50368 -9020 3ta I mix PleaTwrii 1,t.
TSC TEAM MEMBER TO COMPLETE �u 46066
Please include 16 Digit Account Number (31 t) 716 ttlUs
6035 301
NAME CAkt1EL 5 RLIL i DEPT
."Uo Q 1 1Wo f b)
ADDRESS
UFS'li- Jk.l_i} ltd 41W'(41�26t
(;31 5r1 -c;41
CITY STATE I ZIP PHONE 621 n2- 1 r t l3f)1.1
UZ/ 1:3/2000 0.3; i 7r'rl
CUSTOMER TO COMPLETE 7218 ?s5 ullo! 5rm GIN r.i.s i -I
1. 0e) b-? "/6 tiY .'re. rd i
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Fir» +rrnl,.:.n4 Fi�ccr
The undersigned certifies The undersigned party certifies their exemption from �Sl+i,irat at .r VV r
compliance with the agricultural 1 /14
payment of sales and use tax on tangible personal p(�,,
sales tax exemption law of the state as indicated below and /or purchaser is
indicated below and understands property p rtr'tltl W9
engaged in the business of agricultural production of
and agrees with the General liY,yu
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for ss p s x a 601.5
the applicable st tement of the resale and /or uses the farm machinery, equipment or 11Lt'rh ;Ul.3 rr t jyt4t r't:}s t
respective state rinted on the other agricultural production items purchased free of V0 0:00
tax, as defined by state law, and as indicated below. Ctt „alae
reverse side of thi form. u.Uu
(:ash 'Rack
PRODUCT I!JE IN THE FOLLOWING The undersigned party further certifies they
STATE: understand they may be liable for payment of all taxes t ;urYe hr,ut,R er1 the reLL"aP i (if ;a cn 1,¢
REQUIRED) due on the purchase price for the goods as allowed by
(Exceptions: Georgia, New York B Kentucky state law should such oods be used Or Consumed In r.
COMPLETE REVERSE SIDE) g Cf)? Y Df f)I3.i Stif�:� F3.J_P mid the
a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED) the d. c1' ib. 6 rid rch
Resale Under penalty of perjury, signee swears the a ��I,u.rC� With I I.,
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 penalty and/or other provisions as allowed under state
Livestock Production
law'
Floriculture /Aquaculture Production
Other:
ITEMS PURCHASED WILL BE USED FOR: REQUIRED
Farm Machinery/Repair Parts Government Agency (Entity s it u i e t o 3 s
0 Livestock Injestibles or Injectibles Exempt Organization (Entity -a 1. I I:UU i�bh U ?.i4 a i' h i r, d t r c u
NC: only DOT and US Government are exempt can +F' R. o i e a -iu i veY o u J bc: n t e I of j. n a Fertilizer /Agrichemicals flo thl'r dc• aL li 3 1 61 i, Haul I o o k e, a
C] Consumed Production (KS) F1 Resale (Sales Tax Permit $250c' shC,>t' 1 5PP
(c'1 '<rderi ;t:, lii F t Ca 'tt) I,'I� I' {jf4c rlPo t
E] Ingredient or //o��mp n t Parts (KS) ri:i SURVEY F)cC[5S'a�Y. E06. ?60/00.
Other: t/
CUST EKSIGNATURE: (REQUIRED) MGR. APPROVAL
X
IN
CASH CHECK' VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
Ll
DESCRIPTI
Form No. 99.00401 (12105) CUSTOMER ORIGINAL
REIMITTSC BUSPNESS ACCOUNT
TOR PAYMENTS TO:
TRACTOR SUPPLY COMPANY
S UJ)ny CO P.O. Box 9020
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number -160 ?-I 'l
6035 301# (31 C67 "3-110`1
NAME fl r�t 1. r r=Cr T t)rt
3110 131ST i1
ADDRESS (1Cr'TFTF3 11'!
(St() 571-21 it
CITY STATE ZIP PHONE h
i 1 'J31 pflo1 yl) ri I t]4 I rJ
CUSTOMER TO COMPLETE '�7i19:'� f Ft EcdF t1 fT1' RT(r
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 GO, go r' Ot: 2e:8 �d1
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal ,_i:, 1 20
sales tax exemption law of the state property as indicated below and /or purchaser is 0 1 0.O4
indicated below and understands engaged in the business of agricultural production of Ttrl Ps1 20 t)J
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for T� c Cal -L: "QQ r)0
Exemption Statement right and resale and /or uses the farm machinery, equipment or Arc t ;Z' t x 1. r.. e -,1137
the applicable statement nt of the other agricultural production items purchased free of "tttit�_irYLOS31 Ref 0811 W11C
respective state printed on the tax, as defined by state law, and as indicated below. 1 0:bike rocks
reverse side of this form. h,i J .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
(REQUIRED) due on the purchase price for the goods as allowed by :110 c. ei t- c' .a r-t,r: •l C
(Exceptions: Georgia, New York Kentucky state law should such goods be used or Consumed I nt tl
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws. ±f 'tl�,� ;::r;r+ tll Ilirf h +,r n
PURCHASER IS ENGAGED IN: (REQUIRED)
Resa Under penalty of perjury, signee swears the t!i, d: •rr iL-A r I.IZ, r. 1; -r sir; Tl t,. sr
Government information on this statement is true and correct in a.I:Urriatce i.t'1t ;110 G:;rihtl[C•'r• ;L, J.0i,
Exempt organization every material manner. A willfully false representation
Agricult roduction of exemption will cause the purchaser to be subject to
C] Dairy Production
F] Livestock Production penalty and /or other provisions as allowed under state
Flo riculture /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 I I '200. 9 &h -07 -'i w i. t h 11 1 sir„ tj
Fertilizer /Ag rich emicals NC: only DOT and US Government are exempt Cuc,P lr` 1 e a SUr Vkr ;I;rll L,,j en i er el.1 i ll
Resale(SalesTaxPermit# :�mn #hl': d,aliti, !W' a
Consumed in Production (KS)
�c.,sla Stra�f ai'r `11
Ingredient or Component Parts (KS) Gt dod 'i'� 6J i C;rl`r; 7 i!r;
Other: r rr cr. ir. 1.,.
`CUSTOMER'SiGNATURE: (REQUIRED) MGR- APPROVAL
7 X
SE SHAb D hEA O PEKATIVE
CASH CHECK' VISA MIC DISCOVER TSC CHARGE ACCOUNT NO. CHG.. EXCH. DATE
y
`LJ,
r DESCRIPTION
Dl?1 .17a•ia'fri SCL'f1.)SIl7 np :1 )t�J -1J
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
TWT0 11 PAYMENTS TO:
TRACTOR SUPPLY COMPANY
aNy yco P.O. Box 9020 t.,•, r
W Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 1 )4 r i.:-i r<. i i! 4 !l
6035 301
NAME '.rl fr T
P. 1 131"f F
l'r ^r
ADDRESS
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE i
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: i Gr
The undersigned certifies 3GG7�9�
g The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal 1 0 -1 t'
sales tax exemption law of the state property as indicated below and /or purchaser is :en t
indicated below and understands 3;? ?.S1 i ST ^r,r "rj7 �jg;
engaged in the business of agricultural production of
and agrees with the General Q'? food T, Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for i i n I,
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 -!6;(,
reverse side of this form. tax, as defined by state law, and as indicated below. COY 1 u
PRODUCT IS O BE USED IN THE FOLLOWING The undersigned party further certifies they
understand the m be liable for p ayment of all taxes
STATE: Y y p y .{r.; o
UIRED) due on the purchase price for the goods as allowed by nn.rr.,,
Exceptions: Georgia, NewYorkBKentucky state law should such g oods be used Or consumed in f
COMPLETE REVERSE SIDE) g
a taxable manner as defined by state laws. Ell
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in r ar t r �t 1.cJ; r, 5,;,; t,
Exempt organization every. material manner. A willfully false representation r ,r,
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 /A uaculture Production law'
4 .eri,l, k lch,+
Other: t:c nf at.:� '1'i 1 SIC rI•rl�i 1t!7i r 1` Ii,' 1
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity Vii.- ;,,.�q,,t-..:
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 Componen arts (KS)
Othe.
C. It ^rI or 07X 7
C. :.r:'C'. _r JCil t
CUSTOM SIGNATURE: (REQUIRED) MGR. APPROVAL
ii
2 X
USE'SHA AREA 614LY WHEN REGISTER
IS INOPERATIVE.
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT N0. GHG. EXCH. DATE
ITEM NUM BIER NON,,
TAX DESCRIPTIO
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BU S I NESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
0� V C® P.O. Box 9020
Des Moines, IA 50368 -9020 i) �;r, 1}
TSC TEAM MEMBER TO COMPLETE
Please include 16 Digit Account Number
6035 301#
NAME
ApDRESS
CITY STATE ZIP PHONE
CUSTOMER TO COMPLETE
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies The undersigned party certifies their exemption from P"'/ I,(
compliance with the agricultural payment of sales and use tax on tangible personal
sales tax exemption law of the state property as indicated below and/or purchaser is
indicated below and understands engaged in the business of agricultural production of
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and resale and /or uses the farm machinery, equipment or n'i'p
the applicable statement of the c ..,t.. t
respective state printed on the other agricultural production items purchased free of f.t ra d
reverse side of this form. tax, as defined by state law, and as indicated below. V
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they
understand the may be liable for p ayment of all taxes I '''t
STATE: Y Y m
P Y t ,il.tlr� r';!
(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) Il t „C l rc1141' 1I it 1''? t j u y
Resale Under penalty of perjury, signee swears the'
Government information on this statement is true and correct in Lt
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 't i 'lam
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
E] Fertilizer /Agrichemicals
NC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient or Component Parts (KS) t r Y -u} L I. i'+, i r, ::.J L 1 o
Other: uat ).y rl cil... i0 (Jill
if7t..,7 r9"1 ;"141 C� t•cl) i,it 4'h;: {:6�P,3E
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
X
USE SHADED AREA ONLY WHEN REGISTEWIS
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
L3
r ii J',� l .'t'l. JP ':'7!''11,1
:O) DG r: y, it +!.hlt J!'1r.•.; {1'L :I
s^ .r.. .J. 2, t,
Farm No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
RsupnYM.- P.O. Box 9020 tral,
Des Moines, IA 50368-9020 icli")( Uip" ioi pit TEAM MEMBER TO COMPLETE f; �?ii: +t: t c}7'i
Please include 16 Digit Account Number
(6035 301
NAME
3!1A
ADDRESS lli u.,IrLD Tf
CITY STATE ZIP PHONE 2 818518
CUSTOMER TO COMPLETE
12 V N
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 1?,
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 6.00% T:ix
the applicable statement of the resale and/or uses the farm machinery, equipment or 1. J I �1 I 3� 0 3
respective state printed on the other agricultural production items purchased free of
l
tax, as defined by state law, and as indicated below. reverse side of this form,
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they I 'a h' '01, 1 P, t c ('(1 9 7 :19779 1
STATE: understand they may be liable for payment of all taxes f1l)
(REQUIRED) due on the purchase price for the goods as allowed by Ch
(Exceptions: Georgia, Now 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) ca ;Ar e
Resale Under penalty of perjury, signee swears the'
Government information on this statement is true and correct in Q
Exempt organization every material manner. A willfully false representation
Agricultural Production Ot2�;CV I i (I.? J I
F7 Dairy Production of exemption will cause the purchaser to be subject to
Livestock Production penalty and/or other provisions as allowed under state
F Floriculture/Aquaculture Production law.
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
F Farm Machin"/Repair Paris Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
NC: only DOT and US Government are exempt
Fertilizer/Agrichemicals
171 Consumed in Production (KS) F Resale (Sales Tax Permit oi ;!lip. 7 dc;s•7 tr,
F Ingredient or Component Parts (KS) L0I11 F, Jttj•! c Jod 6a i�
Other: .iii' t
1%
d
412 TOM SIG A E QUIRED) MGR. APPROVAL
Ran
X
US ZHAOEUAREA-b OPERATIVE..
MIC?. DISCOVER TSC�CHARGE ACCOUNT NO
CHEC VISA
-Tv C EX CH. DATE
Lk
L -L a
WNUMBER, D S UNI7,PRICE
E CRIPTIOW
Form No. 99-00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
W 1=7011 TRACTOR SUPPLY COMPANY
SU"LYCOM P.O. Box 9020 Tri-c"-r I;t I k.. Co
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 'X,
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 01
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for 2 6. 1 PIT
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 1 109 C 74 24. 1 P T
tax, as defined by state law, and as indicated below. 0
reverse side of this form.
PRODUCT TO qEAJSED IN THE FOLLOWING The undersigned party further certifies they SL,
STATE: 2- understand they may be liable for payment of all taxes
due on the purchase price for the goods as allowed by
(Exceptions: Georgia, New York Kentucky state law should such goods be used or corisurned in
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 11 SIP cill 0
PURCHASER IS ENGAGED IN: (REQUIRED)
V C1, esaie Under penalty of perjury, signee swears the It,": r 0 21 "'3 Z"�<
ove nment information on this statement is true and correct in I
xempt organization every material manner. A willfully false representation
[3 Agricultural Production of exemption will cause the purchaser to be subject to
F1 Dairy Production penalty and/or other provisions as allowed under state
F Livestock Production
F Floriculture/Aquaculture Production law.
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
F1 Livestock Injestibles or Injectibles Exempt Organization (Entity
EJ Fertilizer/Agrichemicals NC: only DOT and US Government are exempt
Consumed in Production (KS) F� Resale (Sales Tax Permit
CUSTOMER SIGNATURE: (REQUIRED) MGR.APPROVAL
CASH CHELA VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. EXCH. DATE
Ll L) U q U 73 L1
ITEM NUMBER-.
FormNo. 99-00401 (12/05) CUSTOMER ORIGINAL
i REMIT TSC BUSINESS ACCOUNT t
�N TWTOR TRACTOR SUPPLY COMPANY
JU P.O. Box 9020
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number t i� l ":f.
6035 301 (3 M C5 r
NAME C1 KTh L 1 "Ulf
3401 I� 1! C' ',;T
ADDRESS
(317) 5?; ?1`
CITY STATE ZIP PHONE
131 431 r:In170 r l x,0',0
CUSTOMER TO COMPLETE 103£a 0 31KI, RA11'i), r 12 x1-
1 .01 P 9 n, rac�
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Wt)" l" 91")
The undersigned certifies The undersigned party certifies their exemption from flovrS ,r1 t FI r: n'. i
compliance with the agricultural h property as indicated below and /or purchaser is ;OOOK.£'S 1 f! iir R M
sales tax exemption law of the state Payment of sales and use tax on tangible personal 1
p 1 G
indicated below and understands engaged in the business of agricultural production of 5twuv tit
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 36T �f, "')ST
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 GaL-Z 111, +r 11 0 ,ens ie
respective state printed on the l
tax, as defined by state law, and as indicated below. reverse side of this form. St-- !,:n l .:.01,7i
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they T`tx 0. ^rl
Y m srarE:
understand the be liable for p ayment of all taxes Tul -o1 2Gs, e7
Y P Y
(REQUIRED) due on the purchase price for the goods as allowed by r`"(, t' w
(Exceptions: Georgia, New York Kentucky
y state law should such goods be. used or consumed in
COMPLETE REVERSE SIDE) r
a taxable manner as defined by state laws. I th:: 035921 n
PURCHASER IS ENGAGED IN: (REQUIRED) PO r' TRUCK 57
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 z�) 1 ud��� I ho
Agricultural Production of exemption will cause the purchaser to be subject to er
F] Dairy Production penalty and /or other provisions as allowed under state`''
F1 Livestock Production a:•v of this ?7.;'� �.l i:• at+:1 iilC ;•1 it
Floriculture /Aquaculture Production law.
Other: IIto Ll"-4cribed r.r" cllat ;h711 F ill
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injestibles 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: Y`.3EIIIItr "II2Z�L8 ^38 ".3PESR�Srr� -P5:
Cal'. 3::� 07:<;• °It�.�t 7 i, 2�
CUSTO R NATURE: (REQUIRED) MGR. APPROVAL
X
USESHADE ONLY
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE.
El
DESCRIPTIO
r
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
k T TRACTOR SUPPLY COMPANY
Niff co P.O. Box 9020
ow law Des Moines, IA 50368-9020
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number F.
(6035 301
NAME
V111 I! 1-41C-f 1, 11
ADDRESS
1 2111
CITY STATE ZIP PHONE
i7l!:1 2 rl�990
f) 0
CUSTOMER TO COMPLETE
1,00 0 'i. �,fj
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. r3-;Vr, n- n i A-scw� if",
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal
sales tax exemption law of the state property as indicated below and/or purchaser is
indicated below and understands engaged in the'business of agricultural production of
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and resale and/or uses the farm machinery, equipment or
the applicable statement of the other agricultural production items purchased free of
respective state printed on the tax, as defined by state law, and as indicated below. 0 00
reverse side of this form.
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they
STATE: understand they may be liable for payment of all taxes Ut
(REQUIRED) due on the purchase price for the goods as allowed b�- tj'
(Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in U^. 1': —2 (1
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED) V I': Id k 1 1,- i)i
n Resale Under penalty of perjury, signee swears the vi'.11 i;1,2
C] Government information on this statement is true and correct in
[3 Exempt organization every material manner. A willfully false representation
F1 Agricultural Production of exemption will cause the purchaser to be subject to
ED Dairy Production penalty and/or other provisions as allowed under state
n Livestock Production
n Floriculture/Aquaculture Production law.
F1 Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) S �,s t t
M Farm Machinery/Repair Parts E] Government Agency (Entity i f; 7 o
F1 Livestock Injestibles or Injectibles 0 Exempt Organization (Entity �:Ll, P101" --tWV07 Alfi LC !)l i Ll i.
INC: only DOT and US Government are exempt ft), i clj�nr.. �t) t,il!
F Ferti lizer/Agrichemicals
F1 Consumed in Production (KS) 7 Resale (Sales Tax Permit k r
�;:irt col�f) On KI
F Ingredient or Component Parts (KS)
0 Other:
0131
ATURE: (REQUI IRED)
3
USE s�HAbIED'AREAltihCY WAEN IS INOP&AT
CHECK M/C DISCOVER C CHARGE ACCOUNT NO. =H EXCH DATE
C] Li a L)
NON
ITEM NUMBER" DESCRIPTI
TAX N' UNIT PRICE_
Form No. 99-00401 CUSTOMER ORIGINAL
RIE(It(IIIT TSC BUSINESS ACCOUNT
PAYMENTS"TO:
TRACTOR SUPPLY COMPANY
RUMMY 2 P.O. Box 9020
Des Moines, IA 50368 -9020
TSC TEAM MEMBER TO COMPLETE
Please include 16 Digi Account Number
6035 301
NAME
ADDRESS
���i) _71
CITY STATE ZIP PHONE 47.1
CUSTOMER TO COMPLETE
i;T
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT:
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural
sales tax exemption law of the state payment of sales and use tax on tangible personal
indicated below and understands Property as indicated below and /or purchaser is i
and agrees with the General engaged in the business of agricultural production of Trr
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for t
the applicable statement of the resale and /or uses the farm machinery, equipment or C't ('�z 31 F t
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. K,
The under art further certifies the
PRODUCT IS TO BE USED IN THE FOLLOWING 9 party 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 Kentucky state law Should such goods be used Or consumed In
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. tx'} t I+ i, t p
PURCHASER IS ENGAGED IN: (REQUIRED) 1 i i i j u J
F1 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.
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles E] Exempt Organization (Entity C 1 f: "u t i i l i T d•' i, n
F Fertilizer /Agrichemicals NC: only DOT and US Government are exempt 0-.
I'OiI`.'; d.,,-:ir" ._r h_i:._ i.,' t.kP 't
Resale (Sales Tax Permit Q r
El Consumed in Production (KS) J0 _,l +P i
Ingredient or Component Parts (KS) (r +I -I a
Other:
CYSTOtAE R S GNATURE: (REQUIRED) MGR. APPROVAL
X
IN USE SHADED AREA ONLY WHEN'kEOISTERIS
H CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO.. CHG. EXCH. DATE
o DESCRIPTIO
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
F
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
P.O. Box 9020 �o
Des Moines, IA 50368 -9020 J1 31 JInr II
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number
6035 301
NAME +r�,li �Ii'.(_f i DEFT
31K)0 tl 15IST ai
ADDRESS (3I;;
CITY STATE ZIP PHONE 131
vlf�ofG;1JS ti:;�
CUSTOMER TO COMPLETE 2. t %1'Sq h:- t'�i1",%n -CJ fI tfE,1
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural mot' °tu i't 3.
sales tax exemption law of the state payment of sales and use tax on tangible personas U Uo)
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
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 r, ;G,2 ,56 Ref :200 ;21 :',5 <51
respective state printed on the other agricultural production items purchased free of Pfd �1; 0'i 2
reverse side of this form. tax, as defined by state law, and as indicated below. Of,, 0
PRODUCT ISTO BE USED INTHE 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, t
(Exceptions: Georgia, New York Kentucky n
state law Should SUCK odds be used or consumed in
COMPLETE REVERSE SIDE) g t:UF AT ,l+ Gt l S :I I. d.v tilt tlic rVI LiI.1:& O
a taxable manner as defined by state laws. r
PURCHASER IS ENGAGED IN: (REQUIRED) 1 i„ 3 CI "if_t`tl I'I i'Ciic `ill +'I,] bc i1',
Resale Under penalty of perjury, signee swears the of dri,Ite {a i'r C�tratt, iJ r t, Ir z.
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
E] Livestock Production n
71 -Dairy Production penalty and /or other provisions as allowed under state
Floriculture /Aquaculture Production law'
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machine /Re air Parts ;i o fi 8 :3 �'cI' S a o 0 3 L` c d e E a a 2
ry p Government Agency (Entity F 1
-9,;ts 0 f"5 ;Ii'iiiLo 6-- Livestock Injestibles or Injectibles Exempt Organization (Entity
Cal.1 w
NC: only DOT and US Government are exempt u +,ir l� i c e j i t t L a s 1 be
Fertilizer /Agrichemical5
di`a'li�t, i 7i C {Ita[rt:;?
Consumed in Production (KS) F1 Resale (Sales Tax Permit Zia 5.,,+ -I�:i r :if I'CC
Ingredient or Component Paris (KS) (',uorieu' ti, <3t 1.,.. CE,i.,r�1 =(Y r. rt
Other.
CUOTOMEFt SIGNATURE: (REQUIRED) MGR. APPROVAL
X
'USE $HAilik
AREA NLYWHEWREGI
CAS CHECK. j VISA MM/ /Cp DISCOVER TSC'CHARGE ACCOUNT'NO: CHG. EXCH. DATE
UNIT PRICE
QUANTITY
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
^(A C4 b r 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
VODCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
G IL 1 CA 5 03 6 G O 0
68o, ti0
ON ACCOUNT OF APPROPRIATION FOR
Board Members
:j0�5 36 1a66651'h60
INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
3► o n o la'1 o t 0 31 (J I �j bill(s) is (are) true and correct and that the
�6IU0o 610 5Z. 0 i. materials or services itemized thereon for
GI to m 5 00 1(0 31 0 U-6- 7 which charge is made were ordered and
I 0 o0fs I q 4 (o of t 69 D received except
oc d 1 i8b 1 0 �3 0
131 r tJ� I io� 7 I c 3' tD 5
ti� a�0 i in 3 to O b `3�1 0 1 o, q
hl 00, 1 (0b 1 Co 10 6 108 ,00
0 Q i8o13®Io oS4 0.01 84.q �f
M AR 0 3 2008 20
Sig a ure
5 lY (0 In 01 ,'�tacw
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund