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155539 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO 1 CHECK AMOUNT: $1,347.82 CARMEL, INDIANA 46032 Po BOX 689020 DES MOINES IA 50368 -9020 CHECK NUMBER: 155539 CHECK DATE: 1/10/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 STREET 17.09 6035301200050860 2201 R4463500 17519 STREET 379.97 6035301200050860 2201 R4356001 17520 STREET 950.76 6035301200050860 I page 1 of 3 Tx 7 DIt�O 78YV7 w sumyco- BUSINESS ACCOUNT 0000516 ACC{,)UNT �t1I��tIAERY t r fi�3a `3012.OQ0� X86© MV Previous Balance 619.21 Closing Date 12/19/07 Payments 0.00 Next Closing Date 01/21/08 CARMELSTREETUEPT Credits 0.00 Payment Due Date 01/13/08 CINDY Purchases 1,347.82 3400 W 131 ST ST Debits 0.00 Current Due 1,347.82 WESTFIELD, IN 46074 8267 FINANCE CHARGES 0.00 Past Due Amount 619.21 Credit Line 5 Late Fees 0.00 Minimum Payment Due 1,967.03 Credit Available 3,282 New Balance 1,967.03 CURRENT ACTIVITY i a i;p� Am {rafiS0Gti6fi Loclattont e�C ftr1 [Ja�aCt tton.: atx y nR NOV 20 GOODS AND SERVICES WESTFIELD IN 119.50 DEC 6 GOODS AND SERVICES WESTFIELD IN 4.93 DEC 6 GOODS AND SERVICES WESTFIELD IN 12.16 DEC 10 GOODS AND SERVICES NOBLESVILLE IN 129.95 DEC 11 GOODS AND SERVICES WESTFIELD IN 379.97 TOTAL 6035301200074803 $646.51 NOV 19 GOODS AND SERVICES WESTFIELD IN 79.96 TOTAL 6035301202895932 $79.96 NOV 26 GOODS AND SERVICES NOBLESVILLE IN 99.95 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Bilking PERCENTAGE Subject to Periodic Nil g PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0A0 00000 30 0.00 0.00 .00000 31 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 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 514.95 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 10/06 902TV5741006 PCT page 2 of 5 7x 7 D113QQQQp0Q TOR v su T myco- i BUSINESS ACCOUNT 0000517 CURRENT ACTIVITY T►BnsacttOn f as .,�Locatwnl ajs:.� .w y" 'ff l a ..,.a «an v 3NM a s �rnaunt x� TOTAL 6035301202896112 $99.95 DEC 10 GOODS AND SERVICES WESTFIELD IN 162.46 DEC 10 GOODS AND SERVICES WESTFIELD IN 143.96 TOTAL 6035301202896120 $306.42 NOV 27 GOODS AND SERVICES NOBLESVILLE IN 114.99 TOTAL 6035301202896138 $114.99 NOV 27 GOODS AND SERVICES NOBLESVILLE IN 99.99 TOTAL 6035301202896146 $99.99 Customer Service and Billing Errors address: PO Box 689161, Des Moines, IA 50368 -9161. CARD AGREEMENT INFORMATION UPDATE. PLEASE KEEP THIS NOTICE. We are adding an optional Pay by Phone Service. This service is disclosed in the following new section which we are adding to your Card Agreement: "Optional Pay by Phone Service. You may request to make your payment by phone using our optional Pay by Phone Service. Each time you make such a request, you agree to pay us the amount shown in the Pay by Phone section on the back of the billing statement. Our representatives are trained to tell you this amount if you decide to use this optional Pay by Phone Service." Did you overlook your payment to us? If so, please send the amount due today. If payment is in the mail thank you! Remit To: Bill To: Page 4 or s 301 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 D= E DEPY.30- 1200050860 JEFFSTEWART WE SUMYCO- N PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000519 Payment Due Date: 01/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP T0: INVOICE: SHIP TD: INVOICE: 431000802226010 431000796108010 Purchase Order: Purchase Order: T R UC K57 111907 AMOUNT DUE: 379.97 AMOUNT DUE: 79.96 Store: 574000431 INVOICE DATE: 12/11 /07 Store: 574000431 INVOICE DATE: 11/19 /07 POST HL DIG POWER GAS 2118956 1.00 219.99 219.99 JKT SNOSTN LG BU CT 37 7305558 1.00 79.96 79.96 3 YEAR SERVICE PLAN 8700028 1.00 34.99 34.99 POST HL DIG AUGER 6 GA 2119326 1.00 124.99 124.99 SUBTOTAL 79.96 TAX 0.00 SUBTOTAL 379.97 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 79.96 TOTAL 379.97 J SHIP TO: INVOICE: SHIP TO: INVOICE: 624000880016010 431000794583010 Purchase Order: Purchase Order: 222 SHOP AMOUNT DUE: 99.95 AMOUNT DUE: 81.22 Store: 574000624 INVOICE DATE: 11/26 /07 Store: 574000431 INVOICE DATE: 11/13/07 BOOT WETL MUCK 11 BR SN 7152010 1.00 99.95 99.95 HITCH PIN 1 /2X4IN 3PT 0268666 10.00 2.78 27.80 PB PENETRATING CATALYST 7036044 1.00 17.98 17.98 SUBTOTAL 99.95 G8 GALV AND COTTERPIN B 3568887 9.35 3.79 35.44 TAX 0.00 SHIPPING 0.00 SUBTOTAL 81.22 TAX 0.00 TOTAL 99.95 SHIPPING 0.00 TOTAL 81.22 J V Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 302 Remit To: Bill To: page s or 5 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 ®S( DEPT.30- 1200050860 MIKE HENRICKS PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000520 Payment Due Date: 01/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP To: INVOICE: 431000802049010 431000802052010 Purchase Order: Purchase Order: 121007 101207 AMOUNT DUE: 143.96 AMOUNT DUE: 162.46 Store: 574000431 INVOICE DATE: 12/10 /07 Store: 574000431 INVOICE DATE: 12/10 /07 SPECIAL ORDER PAYMENT 431051765 1.00 143.96 143.96 BOOT LTHR 61N CES WPRF 7219197 1.00 89.96 89.96 JKT SNDSTN 2X CHOC CT 3 7305469 1.00 72.50 72.50 SUBTOTAL 143.96 TAX 0.00 SUBTOTAL 162.46 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 143.96 TOTAL 162.46 V J SHIP TO: INVOICE: SHIP TO: INVOICE: 624000880692010 624000880531010 Purchase Order: Purchase Order: TRAVIS CLOTHING AMOUNT DUE: 114.99 AMOUNT DUE: 99.99 Store: 574000624 INVOICE DATE: 11/27 /07 Store: 574000624 INVOICE DATE: 11/27 /07 BOOT LTHR WPRF 13M TL27 7281291 1.00 114.99 114.99 JKT SNDSTN LG OL CT 37 7305605 1.00 99.99 99.99 SUBTOTAL 114.99 SUBTOTAL 99.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 114.99 TOTAL 99.99 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 I Remit To: Bill To: Page 3 of s 300 =o TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860�R� DEPT.30- 1200050860 JEFF STEWART WSMMYCO2 PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000518 Payment Due Date: 01/13/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000796419010 431000800710010 Purchase Order: Purchase Order: 11202007 SHOP AMOUNT DUE: 119.50 AMOUNT DUE: 12.16 Store 574000431 INVOICE DATE: 11/20/07 Store: 574000431 INVOICE DATE: 12/06 /07 BIB 38X30 INS EX BK CT6 7021162 1.00 119.50 119.50 NIPPLE MALE TPT 1/2 2110657 1.00 1.29 1.29 NIPPLE MALE TPT 1 2110869 1.00 1.59 1.59 SUBTOTAL 119.50 BALL VALVE POLY 1/2 60 2107507 1.00 9.28 9.28 TAX 0.00 SHIPPING 0.00 SUBTOTAL 12.16 TAX 0.00 TOTAL 119.50 SHIPPING 0.00 TOTAL 12.16 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000800715010 624000887784010 Purchase Order: Purchase Order: SHOP WINTERBOOTS AMOUNT DUE: 4.93 AMOUNT DUE: 129.95 Store: 574000431 INVOICE DATE: 12/06 /07 Store: 574000624 INVOICE DATE: 12/10 /07 BALL VALVE POLY 1/2 60 2107507 1.00 9.28 9.28 BOOT 15M GTX DS WEL TAN 7424873 1.00 129.95 129.95 NIPPLE MALE TPT 1/2 2110657 1.00 1.29 1.29 NIPPLE MALE TPT 1 2110869 1.00 1.59 1.59 SUBTOTAL 129.95 NIPPLE MALE TPT 1 2110869 1.00 1.59 1.59 TAX 0.00 BALL VALVE POLY 1 60411 2107484 1.00 12.32 12.32 SHIPPING 0.00 NIPPLE MALE TPT 1 2110869 1.00 1.59 1.59 NIPPLE MALE TPT 1 2110869 1.00 1.59 1.59 TOTAL 129.95 SUBTOTAL 29.25 TAX 0.00 SHIPPING 0.00 TOTAL 4.93 J Jf Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY C o P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE please include 16 Digit Account Number 6035 301 1't+ =fur NAME .1016V U.:. t�_S "f ,z1 L,� l a ri ADDRESS CMRNEL GThI'-r:T DEFT I CITY STATE ZIP PHONE 'S400 t! 1 a �l 5T ULIt TFT.ELD lit ;607112 (317) 571-2141 CUSTOMER TO COMPLETE "rrSl 431000 2 BOON CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 12;106/2007 11 51,x!, The undersigned certifies The undersigned party certifies their exemption from 2107507 r WINE POLY 1/:. compliance with the agricultural payment of sales and use tax on tangible personal -1100 e V,�, b sales tax exemption law of the state property as indicated below and /or purchaser is G0V,. `r.0k!1t 1 indicated below and understands engaged in the business of agricultural production of 21 1065Y t €IPPLC k' ll_E TPT 1 '2 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for -1,00 0 1 79l Z HT Exemption Statement at right and _resale and /or uses the farm machinery, equipment or f.�tavelt n,it:u f wyicaus the applicable statement of the 211 0067 i` t *UE TPT I respective state printed on the other agricultural production items purchased .free of 1 00 e 1 54 1 5:� Off side of this form. tax, as defined by state law, and as indicated below. (.iUVt l`flFlElli f1`r:titCf2:1 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 2110539 N'IFTLE i TPI 1 STATE: understand they may be liable for payment of all taxes t 00 0 1,S9 I a9 t14 (REQUIRED) due on the purchase price for the goods as allowed by rl wnc i.i?, Exceptions: Georgia, Now York 6 Kentucky- state law should such goods be used or consumed in 107 0 6rNt.t t'I',Lyi[ PPL'! 1 60 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 1 00 e 1. 3 12. NT PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the 21101149 NIPPLE lo)LC IPT 1 Government information on this statement is true and correct in I ,:)0 1. 1 .:i9 I .''3 N!T Exempt organization every material manner. A willfully false representation Gu '6 '00era i Agricultural Production of exemption will cause the purchaser to be subject to 211000 N tIPPL, 'r :�Li fl-y Dairy Production penalty and /or other provisions as allowed under state 1 59 1 59 f1T Livestock Production law. iU'!l''fll "t (i`tLri1 JL i F Floriculture /Aquaculture Production Other: rtttatui'��1 53 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) t I� q T9 x G G �f Farm Machinery/Repair Parts E] Government ,S Government Agency (Entity 1 7''C Cl +t 4 Livestock Iniestibies or Inlectibles L l Exempt Organization (Entity 1 cc: t i t e 3 t 3 8 8 a? 16.01 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt (u t hil 006 R 051 05 1 1 751 Consumed in Production (KS) Resale (Sales Tax Permit ha 1; J 0100 Ingredient or Component Parts (KS)' t a.n Brat.,; Other: ;?I.t;�r �tcicttumll.td:ta�:; tt� r�Eer.tt•T cif cratrll CUSTOMER SIGNATURE: (REQUIRED) MGR.APPROVAL i Or"1 U'r U115 ac, 'tl';t vul cha�N 0 i t X tft rie-ic, -Wed :,Il.rr_h�� ,dl.se sha.tl be ft e CAS`' CHECK VISA'- M/C t DISCOVER TSC CHARGE ACCOUNT NO,' v E: CHG. EXCH, DATE NON DEkFiiIPT Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 'PAYMENTS TO: JE TRACTOR SUPPLY COMPANY S T U I%y P %ore O. Box 9020 Trbctul Des Moines, IA 50368 -9020 11.1 ll,.;. M Oor t l i TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME �0o i; 1 i1st 'r ADDRESS CITY STATE ZIP PHONE I •r 31 •1310001•;7 `l. K071.) CUSTOMER TO COMPLETE z1105 NO! ihrr f/z I,Ut) C CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 1 GI3G;' i!A1 L .;11(_.' ��''I' r compliance with the agricultural 1.C` 1.5; 1.1� 1!T payment of sales and use tax on tangible personal sales tax exemption law of the state Ca::a u,. 11 A., 'ilc,• indicated below and understands property as indicated below and /or purchaser is x 1 1 q L L r engaged in the business of agricultural production of and agrees with the General 1 C i 9 G 'r.: i! I 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 12. reverse side of this form. tax, as defined by state law, and as indicated below. G O l "A 1) PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they f"'`'Z 12. understand the may be liable for payment of all taxes STATE: (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky tlit 6 l' 1067 1� 1.�.: 0 i I QS 7x1::0 COMPLETE REVERSE SIDE) state law should such goods be used or consumed in r•. a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in Exempt organization every material manner. Awillfully false representation B11yet' uS a c(n1i le Agricultural Production of exemption will cause the purchaser to be subject 6 Dairy Production LUPY Uf tlt 5 AIV Sod it'' NLI'L1145l:: o F] Livestock Production penalty and /or other provisions as allowed under state Floriculture /Aquaculture Production law' fits 'de�cYi.�;td chondi -,u air tl b:: if,, Other: aL1:rJrtiailr:( 1:(tt, ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity isr iLive. 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 1 Ingredient or Component Parts (KS) 2oRf,$F: u° 88c� ':.�8 &o8,�II8 "aIIEbEB;kd; ?$8n Other: Tall CCI;-5 !C' %J '3 i ;lifil.i it 7 Jay., r Luf i'1U;,2 uLwvk 6111.1 b(t 0i''t',21 ed An a CtJSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL I �,1oZ X SHA DED AREXONLY WHEN REGISTER IS INO PERATIVE:' C S CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. BATE NUMBER !DESCRIPTIO V PRICE Form No. 99-00401 (ttios) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY )W SUPny C2 P.O. Box 9020 Trttr.2ur f,1u'hlY Cara, ^anr Des Moines, IA 50368 -9020 ?:G7 511 P)-.2a innt St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number -11-.0;0 6035 301 0 1 f) 7 re, 1 F' ".3 NAME l i S'fR'LET DEP 3400 H 131sT ST ADDRESS UFSTf Jr-; -D IN 44()748267 (317) 371 -21•'1 CITY STATE ZIP PHONE 62.4 621000097 2 C,63 92 10/23/20)7 'i 1 1 Sat, CUSTOMER TO COMPLETE 7157002 81001 U TL. HUCK 10 RP CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- 1 00 e y9.95 79 td'f Gcrvr�i nl:lent !;3enci.e'; The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal 95 sales tax exemption law of the state property as indicated below and /or purchaser is 6 r'�r 0.00 indicated below and understands agrees T l al 99.95 and a with the General engaged in the business of agricultural production of g food or fiber, horticulture, aquaculture of floriculture for TSC Card 97.95 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Arr t: EIIxs saaan5f the applicable statement of the FMth 'v:02K-11 �ef�:2310193471 respective state printed on the other agricultural production items purchased free of p p tax, as defined by state law, and as indicated below. PQ t :stew reverse side of this form. Chance 0.00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cr511 Va(' k STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Puy'er acF nrjuled,i the rer_e i e t of a cor•,r 1 e (Exceptions: Georgia, New York Kentucky State law should such goods be used Or consumed Inr >d COMPLETE REVERSE SIDE) y Qf ii+lb Sct 51if' and Ih.-- Purchas- O a taxable manner as defined by state laws. cu PURCHASER IS ENGAGED IN: (REQUIRED) f Resale Under penalty of perjury, signee swears the the da,, r; rchandi_.F shall be it) Government information on this statement is true and correct in acrcir'tl,aoce Lilt,'t thz Cardhold-r A ,ireet.aot. 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) iEEYEa.$ 8o %$8A ?:E:�k$8$$%8II38Raa ^EEEEE Farm Machinery/Repair Parts Government Agency (Entity %E38 808888 %E88:,8 #3308x;,_ „Y bsai83ta Livestock Injestibles or Injectibles Exempt Organization (Entity Ca 800-968-07 'ili V l i n 7 d 1'r s to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt r:uClp 11. c e a Ou r veY Eo)d 6:• EJl r e r?d i n it Consumed in Production (KS) Resale (Sales Tax Permit :QrIti11.Y dra:- !in fora i' ?,a to will a +L.JJD ai"+It':'Xn3 5Fi Ingredient or Component Parts (KS) (At •tr Ord as Gift Card) !1 PhRI'!!.1SE Other: Ole 1 'r "_Y i r_CESiA ?u. Ei 9130100. 88% SiEB d. '`.IIa:EE88S�'IIDfi8aS8 %EE.�a;$II CUST M R SIGNATU (REQUIRED) MGR. AP RO L X USE SHADrb AREA, ONLY CASH CHEC VISA M/C DISCOVER TSC HARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMITTSC (BUSINESS ACCOUNT PAYMENTS TO; T=Toff TRACTOR SUPPLY COMPANY N S UN% YC M P.O. Box 9020 Tractor Supply Corw any Des Moines, IA 50368 -9020 18160 U.S, 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf field, IN 46074 6035 301# (317) 867 -3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFJEI,D IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 431 431000170 1 796108 11/19/2007 10:27am CUSTOMER TO COMPLETE 7305550 JK 5N 1.G 8 CT 1.00 8 -79.96 79.96 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. Government Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 79,96 sales tax exemption law of the state property as indicated below and /or purchaser is 6,00% Tax 0100 indicated below and understands Total 79.96 and agrees with the General engaged in the business of agricultural production of TSC Card 79.9$ esale and /or uses the #a Exemption Statement at right and food or fiber, horticulture, farm ma hir of floriculture for Acct0 tT33TTTTTTSt5932 the applicable statement of the rrm machinery, equipment or Auth0: 019947 Ref 1:1909264936 respective state printed on the other agricultural production items purchased free of PO 0:111907 reverse side of this form. tax, as defined by state law, and as indicated below. Chanse 0,00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed b Buyer acknowledses the receip of a comple (Exceptions Georgia, New York Kentucky state law should such goods be used or consumed Il d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. COPY of this Sales sl ip and the Purchase o f PURCHASER IS ENGAGED IN: (REQUIRED) the described merchandise Shall be in F1 Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in accordance with the Cardholder Asreement, Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and/or other provisions as allowed under state Signature: Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity 1 $312 #3 #3 #3t #t #33$$3333 #3 #33Y #3 #3T$ Livestock lnestibles or lnectibles 1 1 'Exempt Organization (Entity Call 000- 966 -0734 within 7 dais to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Complete a Survey and be entered in a Resale (Sales Tax Permit# monthly drawins for a chance to win a Consumed in Production (KS) '$2500 Shoppins spree. 0 Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9/30/00, Other: %Ykt3Y %$#t %t$t %t$tt3tiY$33% %1133 COST R SIGNATU E: (REQUi MGR. APPROVAL X USE SHADED CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG, ,EXCH. .'DATE V., ITEMNUMBER TAX Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY )W, SUPnY P.O. Box 9020 I,accoi• 5uepiy cooranY Des Moines, IA 50368 -9020 2375 Eaat Pleasant St, TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number tdublesvil lts,iid 4606U 6035 301 t 31 7 76 -1853 NAME CARMEL STREET DEPT 3400 t J 131S 1 51 ADDRESS W ;TFiELD IN 460(45261 (31e: 571 •21�kt CITY STATE ZIP PHONE 624 624000095 1 5506',2 11/27/2007 03:14pi)t CUSTOMER TO COMPLETE 1 281291 BOUT I 'MR dP,'4 1.iri r CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT 1 00 to 1 r 4 en 1 14 V9 rl I The undersi signed certifies Gbvernrenf Asc -ncies g The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal SU6t0t•ai 114,v9 sales tax exemption law of the state p ro as indicated below and /or indicated below and understands prop purchaser is 6.0ux Cax 0.00 engaged in the business of agricultural production of Tota.1 114,99 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for i SE Cirri Exemption Statement at right and resale and /or uses the farm machinery, equipment or Aci-9c sssas3sss�$xt,13B the applicable statement of the Auth�:02i'32.3 kcfv:Z71413529•; respective state printed on the other agricultural production items purchased free of Fp G trrivis reverse side of this form. tax, as defined by state law, and as indicated below. ChAn.,e 0.011 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes Buyer zcJ ;nowied�e:, the receir t of a corlr�le (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( ?d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy of this 5 ^irs ,li.p and the rur•chc!5e o PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the itic described rt:rcilaridise shalt be in Government information on this statement is true and .correct in accordance alitn flit: Cardholder Aarce mien Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production Si tnaillre: C3 Livestock Production penalty and /or other provisions as allowed under state Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) $AtS.4. &$$t8di$$$$ $k$S1E $diII>zIIIIAg�;ggu Farm Machinery/Repair Parts Government Agency (Entity s$ YSS�s $s8 $;xgyg$q$gggyygYxY$Y ;88YL Livestock lnjestibles or lnjectibles Exempt Organization (Entity Call. 800 960-01.51 t1i. thiti 1 da•r a io F 1 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt cOPIPle•te a survey and be onterecf yr, a manhly anct: '(J uLn a tjri~.win� for t 1'.h F Consumed in Production (KS) Resale (Sales Tax Permit dr ow yj, f r i h rc e Ingredient or Component Parts (KS) (A:aar6ed as Gift CaYlf) 1W h'1jJ,(:HA5;_ Other. Uk SURVEY NECESSARY, Ends 9/37/06, u T$ i z. 3 $$$SAIIII8E888YY$8B8LDSAk38E8888t CUSTOMER SIGNAT UD) MGR. APPROVAL 7 7 6 4Z Q X N USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER i TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T�CTO�® PAYMENTS T0: TRACTOR SUPPLY COMPANY off I�'LYco P.O. Box 9020 Tiapar SUPP'IY Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE iNpb v le, IIN '50,,0 Please include 16 Digit Account Number (31 776 6035 301# NAME CARNEI- STI:t ET Tt'-.F'T 3a00 N 13i5T ST ADDRESS 1•je ,i•FTF; D 10 4�G148267 (317) 571 -2131 CITY STATE ZIP PHONE 62'7 624000;)81 2 F'61531 i 1 1G:sent CUSTOMER TO COMPLETE 73fi`',;oa .I',CT SN05T0 1 -G D CT 00 8 99.99 99,99 f1T CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: G�'.er nri�t, A3e nr_ 1e� The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of- sales and use tax on tangible personal �rutal 9 °.99 sales tax exemption law of the state property as indicated below and /or purchaser is 6.f 0% T,ix O,GU indicated below and understands engaged in the business of agricultural production of Totri1 9919, and agrees with the General TSC Cara 9 food or fiber, horticulture, aquaculture of floriculture for ti Exemption Statement at right and A tv aa�ssss t �i ss�t 4�i the applicable statement of the resale and uses the farm machinery, equipment or Atk l la;: 0270(:8 R t 2709353 "90 respective state printed on the other agricultural ural production items purchased free of PI) 3:r,1c1f•tifs�s reverse side of this form. tax, as defined by state law, and as indicated below. Ch�Ao—ie 0.00 The under art further certifies the Cd-,11 Ft;1�L PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty Y STATE: understand they may be liable for payment of all taxes i1 e: i n tt,e r� c 'ir>'i of CUr �1 e (REQUIRED) due on the purchase price for the goods as allowed by. d (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. cart tli i1,: ,8)t'S dS, tll.' f Ui ci i7c U PURCHASER IS ENGAGED IN: (REQUIRED) f ii7; C {;:�CI't(72i1 rt_'rr.)f, .F' Sh'41,7. (ji j,p Resale Under penalty of perjury, signee swears the lccu 'dance w I tf:e Cru'dtit.tldc'r A,r i C I t 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 F1 Livestock Production penalty and /or other provisions as allowed under state Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock lnjestiblesorinjectibles Exempt Organization (Entity Call 0- 768 6734 .liihiri 7 daYS !u NC: only DOT and US Government are exempt cL-,rr• le t; r) ,nrvaY rd be e tc•r ed iii a Fertilizer /Agrichemicals tioaUtiY dr:w�n•, for .t Lil,�•tr.0 to ai,i �I Consumed in Production KS Resale (Sales Tax Permit F1 ,2500 ,.n-1 Ingredient or Component Parts (KS) (Awrir Feu: as i f. f i C `rd) t (7 F UR,"VA5E Other: E88EII�IIR�. 1528 ;S8S8S8�:z,)Z�'- �ZR.i48 -;II�2 CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X SHA USE AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL �f�. REMIT TSC BUSINESS ACCOUNT RAC TOR PAYMENTS TO: TRACTOR SUPPLY COMPANY SU P.O. Box 9020 Des Moines, IA 50368 -9020 18160 U.S. 31 ;!or ;h TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number .1i ;r, 6035 301# (317) 86? -3505 NAME [t'RIMEI_ STREET mLPr P(M f•i 13151 J ADDRESS U wFI£I_D R Bi 511 -2111 CITY STATE ZIP PHONE 431 131 7 79. 419 CUSTOMER TO COMPLETE 7x21 162 DID 3E',:. °.0 xi': i Ex 1310 1 Ofl 1 19 5u 119.51, NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Goverrtr;ent h3ei,Lie5 The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Stibtotol 1141,S9 sales tax exemption law of the state ra” 0 indicated below and understands property as indicated below and /or purchaser is Tofyll 11" `,ir1 engaged in the business of agricultural production of 1 and agrees with the General 1y, food or fiber, horticulture, aquaculture of floriculture for Al-c i x t r Exemption Statement at right and resale and /or uses the farm men machiner y, equipment e ui t or 503 the applicable statement of the 0t0h:' :OtO?0 hef; :200916112s respective state printed on the other agricultural production items purchased free of 1'G 0 :1120 reverse side of this form. tax, as defined by state law, and as indicated below. The under art further certifies the C`vlh Bich PRODUCT IS TO BE USED IN THE FOLLOWING g p y y STATE: understand they may be liable for payment of all taxes gLlver reCe lP t (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 i6" COMPLETE REVERSE SIDE) LCt: OF t11.tF, S3� blip iod the I'LIVOIA C 0 a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) the det,cr:i'at:d fief Li,t�ltdl 5111111 Fte 111 Resale Under penalty of perjury, signee swears the t,Lcol'drlace tr ;i�h tilt Cat'd1ull�fL; A:�rrtr.,cat. E] 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 'l�Jndture: Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) x 3 3 8 3 L'1 II t d E 3'3 :1) II II X J Farm Machinery/Repair Parts Government Agency (Entity Livestock In estibles or In ectibles C,n.l t F,'t7•� 76L' -073 LJi ?itlil 1 dikyY, tU i 1 Exempt Organization (Entity cur.'I�1r -1F' a svrve> and be c;Itered in NC: only DOT and US Government are exempt F] Fertilizer /Agrichemicals LIUt1Y1L1Y �1'fcari113 UY t Consumed in Production (KS) E] Resale (Sales Tax Permit ticittr'C rfl 01 i! $2500 i)hai -r i n �t SP 1 re Ingredient or Component Parts (KS) (I)trardvd Gift Cart,) Mi PUitC 10.5i 05� SGURIBEY P1 L ivl1 9, M Other: i:u ;'Ia:B >.;fiu8i838`I„t?: ::il:3L CUSTOMER S GNSA�T�U�R,E: (REQUIRE MGR. APPROVAL ��Cc1�.. `µms X SHA DEb AREXONLY-WHEN"REGISTERAS CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE NUMBER NON DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REWTTS BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY S TU'Fn y P.O. Box 9020 T r `i ur Stw F T Y C0'4"Z. v Des Moines, IA 50368 -9020 il31s i7 S .s1 E, t;+ L s�f it w, Sf 'taC,'•; TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number r 9 x;517) Ctir 3�ta`. 6035 301 NAME l.ARNEL S 1 REE'l DEFT 3 403 tl 131 ST 2T 19' SIT IELD 1 1'1 '41071626( ADDRESS 1 f) 57 21 41 CITY STATE ZIP I PHONE 4.� 1 4310001 2 02057 12/;O//001 0.3 20i -I CUSTOMER TO COMPLETE i'219197' Boor L'TH, nrrl cf,::i t 1.00 P 99, Soh IRV 96 tr r CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. Gaverniner� As: -nc.io ertifies 4'305 4'305 JV1 5;115T{) 21: The undersigned :FIOC L g The undersigned party certifies their exemption from i '00 72,501 r2.:,0 ;!T 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 1 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for ,,fir as 6 Exemption Statement at right and 0 0 the applicable statement of the resale and /or uses the farm.machinery, equipment or 167 ;;6 respective state printed on the other agricultural production items purchased free of Tl;" Car.,i IQ 6 reverse side of this form. tax, as defined by state law, and as indicated below. 1=;,. cY4:lt *3t gx zs ss6120 f:u h;, 010076 fit. ='f :10147.0;•456.1 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they PO ti f 0120; STATE: understand they may be liable for payment of all taxes C1�a�ty 0,0+j (REQUIRED) due on the purchase price for the goods as allowed by L4!Z11 ):OL k (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. Luyer u 1,nit �lel�t ilrr es_r ir° t c, �r c It PURCHASER IS ENGAGED IN: (REQUIRED) f y, d Resale Under penalty of perjury, signee swears the cows aY fi1ii; �aTeS <,zz� rrd tf, rut ii;.+�� a Government information on this statement is true and correct in Exempt organization every material manner. Awillfully false representation ih drscri6erd I,a; cFt�.ntli sit��ll t;. n Agricultural Production of exemption will cause the purchaser to be subject to CCUr z tttt fiI 1 Carr "tultfi: Dairy Production Livestock Production penalty and /or other provisions as allowed under state Floriculture /Aquaculture Production law' Other: 5i:,;lu'tUre: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity 1 [J Livestock Iniestibles o Iniectibles E:] Exempt Organization (Entity FertilizerlAgrichemical NC: only DOT and US Government are exempt a'3;$yttS38.fi78P ti }:dTn; R85 83�� >Yf.;u F1 Consumed in Prot(uc do (KS) Resale (Sales Tax Permit Ca-P. C00 -960 Q7;$ 1 wi •tlait 7 day to carlr lr ::ui v a:rd be enfiel ur1 in c' Ingredient or Comp nentParts(KS) ourrt'lrly dvaui' +'r5 roe a c6a9r� la t;,L'r+ r, Other. 4-'A0 ,i+:1 rJ n1 -rL Ot- f>.rdud a5 Gitr Care) i%Q F'U;;CHO`tE CUSTOMS I AT RE: (REQUIRED) MGR. APPROVAL 1 X e s• 7A5H i CHECK VISA' M/C `DISCOVER TSC CHARGE`ACCOUNT N0.. CHG `i EXCH. ,DATE ITE M NU M13EA DESCRIPT Form No. 99 -00401 (12 105) CUSTOMER ORiGiNAL REMIT TSC BUSWESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SYC2 P.O. Box 9020 Tr itC'iuI Suer I Cw i :si Des Moines, IA 50368 -9020 131:50 U. st I'.l�rr tl TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number ©6 35u u`5t''r 7L1' 4 "'0 (3t 6035 301 r'1 NAME 131 1131000175 r "5 2 GuZ0 ,4 12/10/2007 03:13.-5 ADDRESS 0 17 SPECIAL tit- ct.i�11. fil'tfer a: 4131051'76'.7 CITY STATE ZIP PHONE CA` Ir')~ ST ZET n 3100 IJJ 131Gf SI U."PUICLD T.N' -W 7 CUSTOMER TO COMPLETE (31 Y) }'7f 2111 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 0222220 SA ID5TCEN`E $113 The undersigned certifies The undersigned party certifies their exemption from 1 00 0 71. "t• Compliance with the agricultural a =,t 'i tt n'1 tl: 420;.101, sales tax exemption law of the state payment of sales and use tax on tangible personal Q722E2r1 Ct';; E :;!;Ttl'�� IB indicated below and understands. t food or fiber, horticulture, aquaculture of floriculture for property as indicated below. and /or purchaser is C=7 r '1 I B r'1 .Yr3 and agrees with the General engaged in the business of agricultural production of ell .C� l ,deli 111 sr; 1, iztt r I Exemption Statement a right and resale and /or uses the farm machine equip ment or the applicable statement of the machinery, S,©tot41] respective state printed on the other agricultural production items' purchased free of 6 007 Tax O V0 reverse side of this form. tax, as defined by state law, and as indicated below. Tc 7,1 1r3.96 Th t further certifies th 0c`' "'L' t i3.'.v The under ar PRODUCT ISTO BE USED IN THE FOLLOWING p arty 3'r understand the may be liable for payment of all taxes '0 CaT d 13 9u srarE: Y Y p Y F,ct,:;Z�ssa'a:sf t i (REQUIRED) due on the purchase price for the goods as allowed by I ;,U 01 tiE1�l7 t�:* i %3 ;101 •t 1 f17.5'� 5 (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) PO s 1 21 N e a taxable manner as defined by state laws. II it 0 a0 PURCHASER IS ENGAGED IN: (REQUIRED) S E: $tick Resale Under penalty of perjury, signee swears' the [J Government information on this statement is true and correct in F Exempt organization every material manner. A willfully false representation PRl.rtlil 1 1111 0. (iu El Agricultural Production Nikver f Dairy Production of exemption will cause the purchaser to be subject to L i penalty and /or other provisions as allowed under state. Livestock Production col'y of 1111:55 513Q. 51.tr /ltd thu rtirchA5e u Flo riculture /Aquaeulture Production law' f other: Inc Derch�indi- sha h in ollcofdal]Le Nith ii;. CrSrtfhnic` r ftsieekilt_nx, ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity r al snt u. I FertilizerlAgriche als NC: only DOT and US Government are exempt F] Consumed in P o uction (KS) Resale (Sales Tax Permit Ingredient or Qo ponent Parts (KS) Other: ^,8x1> X32 %SS: %'3St ?SSr�,Brs Caii 000.960 -073.1 ki.ihtn Y J,Iy C5, CUSTOMER IG 'TURE:(REQUIRED) MGR. APPROVAL CU:.K'�L'ic. is svrvk.) n4U1 b e vitiered tr P '.1unihly Craoim, for rtli'..-T.Co +0 dill :t X s CASH CHECK VISA M/C DISCOVER= TSCCH7IRGEACCOUNTNO. ;_r` CHG.,` EXCH.`.DATE ?t' NiT Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REFIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SU"LYC2 P.O. Box 9020 Tractor SuPf Cultit Des Moines, IA 50368 -9020 2375 Eabt Pleasant St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number ido6lesvi,t.tt: i.l 46060 6035 301 (3 1 7 6 1 88 S NAME CA4r1EL WEt'f ➢EF't 34UO W 131 131 ADDRESS 11ES(F1Et_)3 IN 460748267 (:f1f) 3 ?I-7.1ft CITY STATE ZIP PHONE 62a 62400008/ 1 888'(84 12/10/2007 oc:ispr,t CUSTOMER TO COMPLETE 74 '4873 DOW i Sit SIX 0S UEL I •00 0 129. r,) CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gave; l)rrivnt Asencle" The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 1s' sales tax exemption law of the state property as indicated below and /or purchaser is 6. oo; (a:x 1t •uu indicated below and understands lotal i2y,y5 engaged in the business of agricultural production of and agrees with the General TSt, L`art,f 1'r_'l,slt3 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 01 00j., Itef :101.St2574,s respective state printed on the other agricultural production items purchased free of f:,p 0;aitl4tir bQrstts reverse side of this form. tax, as defined by state law, and as indicated below. Uhi n. e 0. 0o Thi ned further certifies Lash 8`'cl' The under art PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty th STATE: understand they may be liable for payment of all taxes Buyer acknuviedscs 'thc receir-i of c1 t le (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. r c r `1f this 'a�tLeS stir and the wurcFl�l,e o PURCHASER IS ENGAGED IN: (REQUIRED) ill dC5E1'itlEd r;erchartdz "iE steal.] 13e ).n Resale Under penalty of perjury, signee swears the af_rorrianE:c with tflc ar[ihuldc r' Asreerten'i F 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 p urchaser to be subject to F1 Dairy Production p p 1 5isna f'LIrL:: I Livestock Production penalty and/or other provisions as allowed under state Floriculture /Aquaculture Production law' Other: ITEMS PURCHASED. WILL BE USED FOR: (REQUIRED) 3 Yjtg3 3$SZ *3$a;x Farm Machinery/RepairParts Government Agency (Entity C j.f d Livestociclnjestiblesorinjectibles C] Exempt 0 "1:54 with,tt liay', to ExemptOrganization (Entity conw)ete' a su rveY and be eittE` red In a NC: only DOT and US Government are exempt FertilizerlAgrichemicals t +tanthly daal.lit3s frjr a 6 1.i-lia a Consumed in Production (KS) Resale (Sales Tax Permit 12500 shoe i n SY ree (A ardt_ is Gl 1 C:,+F0) ;die i''tlRI14A;�t. Ingredient or Component Parts (KS) OR SO VEY NECESIiARY. I:ur3 /Jp1Uci. Other: $El it 8fikS$ 5; 8:68331: t s.s:3ks CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL, X ONLY USE SHADED CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT N0. CHG: EXCH. DATE' Q Ll U DESCRIPTION ITEM NUMBER- Form No. 99 -00401 (12105) CUSTOMER ORIGINAL i REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: liii'If}VMR TRACTOR SUPPLY COMPANY SUZY P.O. Box 9020 Des Moines, IA 50368 -9020 T' k' i(. r11 1I. G t.3 1 P', o 3 I� tit TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number I +::,t f 1, 1L1, ►.'r1 o 6035 301 COY) 17) t)67 3`10.5 NAME 3;�,r) :J 1Y1S1' SI ADDRESS t;. s f i 1CLU W :6(+;'�3i6'P (ii r) Srt 71 ell CITY STATE ZIP PHONE 1;1 431 r (f 2 007276 17/11/207 10' 36'ir CUSTOMER TO COMPLETE ?1 iCr`53 r H�_ i}rti f'(1ta. 0 011 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- I Go e i 9 vJ 111.99 i''1 Ga��.-t'nnl :art fi`:rnr;ic The undersigned certifies The undersigned party certifies their exemption from 0000213 3 'tE('1R ;;I _'R1 +1(::_ PI.P�. compliance with the agricultural payment of sales and use tax on tangible personal 1 00 C 99 /a.: r''f 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 F ur .:csti.ur ibr i i-`at•ot• N f'?. in and agrees with the General food or fiber, horticulture, aquaculture of floriculture for F'leatie 1., {l1 1- 76:; -"L60. 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 Cuverrtcx .lt 119enLlte:, respective state printed on the tax, as defined by state law, and as indicated below. 7.1111 1'ST HL "'(Fi f,tllil-:r; 6 reverse side of this form. 1 1 00 2 1 Z1,( 1L4,99 Nt PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Gvi.­,�rnror, STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Z 1 (Exceptions: Georgia, New York Kentucky state law Should such goods be used or consumed in 6.0 i (el,( COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Yo 1 a 1 3 (9 PURCHASER IS ENGAGED IN: (REQUIRED) l `;r Lit U Z 9. 1 2 t' Resale Under penalty of perjury, signee swears the fi Lt 31 0:: Government information on this statement is true and correct in Au i ltv :011842 Ref :1109,6?5CI Exempt organization every material manner. Awillfully false representation `0 c: i r L'�L i f;7 Agricultural Production of exemption will cause the purchaser to be subject to chi:vl oe 0. 0 Dairy Production penalty and /or other provisions as allowed under state l ,t;lt 1r 1 E3 Livestock Production law. Floriculture /AquacultureProduction 1;UYer .r_hnnGit'd:;is iflc rece,l t U( <I cur.�le Other: 1 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) C['1'Y C; {i1i 511.Ef si.Ar old :i rt.u'Ch15ht O Farm Machinery/Repair Parts Government Agency (Entity i alt d.. r a, d I:. �1 c; ..r i i!t I 1;11. l;,e lif Livestock Injestibles or Injectibles Exempt Organization (Entity u- +_artJaoLi 1,i i i i i:e L', +t uiruiu�r I' ;r t._sErl t Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit it .1 iure: Ingredient or Component Parts (KS) Other: CUSTOIp R S G A�(IRED) MGR. APPROVAL X PSE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L3 7 DESCRIPTIO Form No. 99 -00401 (12/05) 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) la- a ti q3 W-1 u 1� i z ►�f a� C Ic�l �u� R 4, qg i�l. III. 4q R q. y 9 Ili Z_ k I iC1 50 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in acco rdance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. L ALLOWED 20 IN SUM OF 1A t)03-- gok.D ON ACCOUNT OF APPROPRIATION FOR Board Members ,PO r INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or I "15 �3►000BOIIIiPctp 06 3'l�t, q� bill(s) is (are) true and correct and that the Obi 0008 I I cy 6 1 materials or services itemized thereon for 6,0008W1 15010 'Y-t 3 which charge is made were ordered and 1 "(5 kb �61 0wlgt4 I gr 10 51Qo, 01 11q, SO received except II��a 1r��10(�88`1�5� IG 5 0,01 l�Q,�l' I `15 Lo 4610000OI -Ig d o 5lao, of N 6A (f 5�o 1 000 8ow0) olc 5lvo, 1 ei,4( (75�� le�,l000,&Bo�9 to �eo,o! iii :�y i'15�� (D��� So531 lip 5�0: of Wa, a s I "(5 O "3uo7q(.ia c 5 00,o( 7 G. G i75Lo ioLa wb&8 olko I 1)00.oL 3.1' 2003 20 Signat �Y r C �'-"A' (Yn- Title Cost distribution le ger classification if claim paid motor vehicle highway fund