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Home My WebLink About162518 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 0 ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $1,379.89 `4 CARMEL, INDIANA 46032 PO BOX 689020 DES MOINES IA 50368 -9020 CHECK NUMBER: 162518 CHECK DATE: 8/7/2008 DEP ARTMEN T ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 664.40 6035301200050860 2201 4238900 335.04 6035301200050860 2201 4356001 29.96 6035301200050860 22.0,1 4467099 350.49'6035301200050860 ,r. I page 1 of ''6 TX D 1 Vsumyco- TOR' BUSINESS ACCOUNT 0000454 O� ACCUgA §gMM�ARY 6.03— s- 12 OQOa �86Q r Via-_ :.a.a.u, w:'��H:. Previous Balance 78.76- Closing Date 07/21/08 Payments 0.00 Next Closing Date 08/19/08 CARMEL STREET DEPT Credits 0.00 Payment Due Date 08/15/08 CINDY Purchases 1,379.89 3400 W 131ST ST Debits 0.00 Current Due 1,301.13 WESTFIELD, IN 46074 -8267 FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 1,301.13 Credit Available 3,948 New Balance 1,301.13 CURRENT ACTIVITY s Transaction Location/ Amount j I�At6�r r� .:F. (@SGt iptiOn4 w5 a r� JUL 7 GOODS AND SERVICES WESTFIELD IN 117.46 JUL 14 GOODS AND SERVICES WESTFIELD IN 160.90 TOTAL 6035301200074803 $278.36 JUL 7 GOODS AND SERVICES WESTFIELD IN 69.92 TOTAL 6035301200074837 $69.92 JUN 18 GOODS AND SERVICES WESTFIELD IN 350.49 TOTAL 6035301202895932 $350.49 JUN 26 GOODS AND SERVICES NOBLESVILLE IN 285.97 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daly Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic B llug PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 33 0.00 0.00 .00000 3o 0.00 t This Account Issuedb Citibank South Dakota N.A. CUSTOMER SERVICE 1- 800 559 -8232 FAX NUMBER 1- 801 779 -7425 Notify U5 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: o 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. 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 k page 2 of 6 T6 7 D i V v Vs uety c BUSINESS ACCOUNT 0000455 CURRENT ACTIVITY �Tf8fIS8Ctf011 Nos i M �M LOC2t�O1V d��P OAt@ ,rx IaBS�GEI 1IQ11 y Leh 010 z rent g n JUN 27 GOODS AND SERVICES WESTFIELD IN 41.98 JUN 27 GOODS AND SERVICES NOBLESVILLE IN 121.94 JUL 7 GOODS AND SERVICES WESTFIELD IN 29.94 TOTAL 6035301202896013 $479.83 JUL 3 GOODS AND SERVICES WESTFIELD IN 47.12 JUL 15 GOODS AND SERVICES WESTFIELD IN 19.99 TOTAL 6035301202896120 $67.11 JUL 3 GOODS AND SERVICES WESTFIELD IN 29.96 TOTAL 6035301202896138 $29.96 JUL 18 GOODS AND SERVICES WESTFIELD IN 17.98 TOTAL 6035301202896153 $17.98 JUL 16 GOODS AND SERVICES WESTFIELD IN 86.24 TOTAL 6035301202896161 $86.24 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." r Remit To: Bill To: Page 3 or s Lbtl =o TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050960 DEPT.30 1200050860 JEFF STEWART ®sumycs PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000456 Payment Due Date: 08/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN ra SHIP TO: INVOICE: SHIP TO: INVOICE: 431000855620010 431000857557010 Purchase Order: Purchase Order: SHOP 71408 AMOUNT DUE: 117.46 AMOUNT DUE: 160.90 Store: 574000431 INVOICE DATE: 07/07 /08 Store: 574000431 INVOICE DATE: 07/14 /08 BINDER CHAIN G70 VC 3/8 3543829 1.00 65.47 65.47 LACQUER THINNER GA 3441069 1.00 13.99 13.99 LIGHTS TONING MAGNETIC 1069332 1.00 51.99 51.99 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 SUBTOTAL 117.46 PAINT REST PT HARDENER 3474509 1.00 20.98 20.98 TAX 0.00 PAINT T8T GAL GV PRIMER 3466213 1.00 27.99 27.99 SHIPPING 0.00 PAINT TSI GAL IH RD 3449570 1.00 27.99 27.99 PAINT T8I GAL IH RD 3449570 1.00 27.99 27.99 TOTAL 117.46 SUBTOTAL 160.90 TAX 0.00 SHIPPING 0.00 TOTAL 160.90 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000855720010 431000850400010 Purchase Order: Purchase Order: 70708 REFLECTINGPOOL AMOUNT DUE: 69.92 AMOUNT DUE: 350.49 Store: 574000431 INVOICE DATE: 07/07 /08 Store: 574000431 INVOICE DATE: 06/18 /08 RCOAT REF TAPE 3X LIME 7046112 1.00 34.96 34.96 TRAILER TILT 4X6 2000GV 1011070 1.00 349.99 349.99 RBIB REF TAPE 3X LIME G 7046188 1.00 34.96 34.96 SUBTOTAL 349.99 SUBTOTAL 69.92 TAX 0.50 TAX ---.----0.00 _SHIPPING ------0.00 SHIPPING 0.00 TOTAL 350.49 TOTAL 69.92 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 i Remit To: Bill To: Page a or s TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860C�R� DEPT.30 1200050860 MATT HIGGINBOTHAM ®SUP UO2 PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT DES'MOINES IA 50368 -9020 0000457 Payment Due Date: 08/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP To: INVOICE: 624000983357010 624000983970010 Purchase Order: Purchase Order: 62608 62708 AMOUNT DUE: 285.97 AMOUNT DUE: 121.94 Store: 574000624 INVOICE DATE: 06/26 /08 store: 574000624 INVOICE DATE: 06/27 /08 PACER PUMPS SERIES 825 2136019 1.00 249.98 249.98 LIFT SLING 21NX8FT ENDL 3012064 1.00 20.99 20.99 ANGLE BALL VALVE 2 BOLT 2107581 1.00 35.99 35.99 LIFT SLING 21NX8FT ENOL 3012064 1.00 20.99 20.99 STRAP 2INXISFT SOOOLB R 3020130 1.00 19.99 19.99 SUBTOTAL 285.97 STRAP 2INXISFT SOOOLB R 3020130 1.00 19.99 19.99 TAX 0.00 STRAP 21NX15FT 5000LB R 3020130 1.00 19.99 19.99 SHIPPING 0.00 STRAP 2INXISFT 5000LB R 3020130 1.00 19.99 19.99 TOTAL 285.97 SUBTOTAL 121.94 TAX 0.00 SHIPPING 0.00 TOTAL 121.94 SHIP To: INVOICE: SHIP TO: INVOICE: 431000852850010 431000855701010 Purchase Order: Purchase Order: 62708 70708 AMOUNT DUE: 41.98 AMOUNT DUE: 29.94 Store: 574000431 INVOICE DATE: 06/27 /08 Store: 574000431 INVOICE DATE: 07107 /08 LIFT SLING 2INX8FT ENDL 3012064 1.00 20.99 20.99 CHAIN 3/8 GRADE 70 TRAN 3586518 6.00 4.99 29.94 LIFT SLING 2INXBFT ENDL 3012064 1.00 20.99 20.99 SUBTOTAL 29.94 SUBTOTAL 41.98 TAX 0.00 TAX .0. 00 __.SHIPPING____ __0..00 SHIPPING 0.00 TOTAL 29.94 TOTAL 41.98 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801- 779 -7425 �I i Remit To: Bill To: Page s or s 41 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 i R 1 DEPT.30 1200050860 MIKE HENRICKS ®Su"LYCo- PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000458 Payment Due Date: 08/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP To: INVOICE: 431000854666010 431000858012010 Purchase Order: Purchase Order: 70308 71508 AMOUNT DUE: 47.12 AMOUNT DUE: 19.99 Store: 574000431 INVOICE DATE: 07/03 /08 Store: 574000431 INVOICE DATE: 07/15 /08 TOP LINK BUSHING CAT 1 0268446 1.00 1.79 1.79 HAIRPIN COTTER KT 1833448 1.00 19.99 19.99 CAT BUSHING 3 -2 3PT TOP 0267945 1.00 1.99 1.99 CAT BUSHING 3 -2 3PT TOP 0267945 1.00 1.99 1.99 SUBTOTAL 19.99 TOP LINK BUSHING CAT 1 0268446 1.00 1.79 1.79 TAX 0.00 TOP LINK BUSHING CAT 1 0268446 1.00 1.79 1.79 SHIPPING 0.00 TOP LINK BUSHING CAT 1 0268446 1.00 1.79 1.79 HANGER W 91N BOLT 3551848 1.00 35.98 35.98 TOTAL 19.99 SUBTOTAL 47.12 TAX 0.00 SHIPPING 0.00 TOTAL 47.12 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000854648010 431000858859010 Purchase Order: Purchase Order: 70308 WATERTRUCK AMOUNT DUE: 29.96 AMOUNT DUE: 17.98 Store: 574000431 INVOICE DATE: 07/03 /08 Store: 574000431 INVOICE DATE: 07/18/08 RCOAT HOOD OLGN XL WG64 6459728 1.00 29.96 29.96 JS PLIERS 161N GRVJT 3810470 1.00 8.99 8.99 JS PLIERS 161N GRVJT 3810470 1.00 8.99 8.99 SUBTOTAL 29.96 TAX 0.00 SUBTOTAL 17.98 SHIPPING. .0..00 _TAX- 0...00_ SHIPPING 0.00 TOTAL 29.96 TOTAL 17.98 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 i Remit To: Bill To: Page s or s TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 v Ml DEPT.30 1200050860 SHAUN PRIVETT PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DESMOINES IA 50368 -9020 0000459 Payment Due Date: 08/15/08 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: 431000858322010 Purchase Order: 7162008 AMOUNT DUE: 86.24 Store: 574000431 INVOICE DATE: 07/16 /08 PRAMITOL 2 -1 /2GA 4202662 1.00 86.24 86.24 SUBTOTAL 86.24 TAX 0.00 SHIPPING 0.00 TOTAL 86.24 J i Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 I� REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY UPPLYC2 P.O. Box 9020 A r i Des Moines, IA 50368 -9020 i )'.:J. i TSC TEAM MEMBER TO COMPLETE I Please include 16 Digit Account Number 5� 6035 301# NAME j•.11, I ,1.7! !•I ADDRESS CITY STATE ZIP PHONE i CUSTOMER TO COMPLETE I, 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 I Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for resale and /or uses the farm machinery, equipment or the applicable statement of the r• -.I i 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. PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they a be liable for p ayment of all taxes STATE: understand they may P Y (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky State law should such oods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in 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 A,, I r- Floriculture /Aquaculture Production law' Other: CIA i:11 _,r}! At.0 ii..: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) j I i.i. 1J.. 4.: l t,,. Farm Machinery/Repair Parts i, i Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CU TO SI ATURE: (REQUIRED) MGR. APPROVAL a �a X SHA OSE AREA ONLY WHEN REGISI r-K Ib INOPERATIVE. M57 CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTION Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T�C�I�® PAYMENTS TO: TRACTOR SUPPLY COMPANY SU myco P.O. Box 9020 Des Moines, IA 50368 -9020 10 1 U. y ;:I 1 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS i `i I t i_!i CITY STATE I ZIP PHONE •iii t.ttit ii. CUSTOMER TO COMPLETE t U 'J; I, CERTIFICATE OF EXEMPTION' GENERAL EXEMPTION STATEMENT: rl i.. r,•_ The undersigned certifies The undersigned party certifies their exemption from I I'?, !/41 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 the applicable statement of the resale and /or uses the farm machinery, equipment or respective state printed on the other agricultural production items purchased free of reverse side of this form. tax, as defined by state law, and as indicated below. PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they r I may be liable for p ayment of all taxes STATE: understand they Y P Y LI,:,- ;,1yn_'v�i r(�,_,•'..,:: (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. L 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 I, c 3 S every material manner. A willfully false representation 1 Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production F 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 ii I r J i11 1 u „l n Livestock Injestibles or Injectibles Exempt Organization (Entity NC: only DOT and US Government are exempt t r,,' 'r 5L r 6`'', 1 '1 Fertilizer /Agrichemicals ��:i J,i ;iin l l i;, rUi "._1. :i r -�i .:a•. Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: C STO ER IGNATURE: (REQUIRED) MGR. APPROVAL l X USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. A CHECK VISA M /C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL j REMIT TSC BUSINESS ACCOUNT IF T PAYMENTS TO: TRACTOR SUPPLY COMPANY evi YC® P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301# NAME ADDRESS 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 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 L• t 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 `'r r STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by 'r•' (Exceptions: Geor New York s Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) I 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 Agr i c u lt ural Production Dairy Produotion of exemption will cause the purchaser to be subject to Dairy Pr i 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 Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit r Ingredient or Component Parts (KS) Other: C ST ME NATURE: (REQUIRED) MGR. APPROVAL O 1 v USE S1 e 4LY WHEN REGISTER IS INOP ERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT IV TWTOR PAYMENTS TO: TRACTOR SUPPLY COMPANY 5�� P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE I" Ll'- 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 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 I other agricultural production items purchased free of r respective state printed on the tax, as defined by state law, and as indicated below. reverse side of this form. The 'undersigned art further certifies the PRODUCT IS TO BE USED IN THE FOLLOWING 9 party they STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: 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) 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 r Floriculture /Acluaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR:(REOUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL Z 7J X USE AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TOR PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLY Co P.O. Box 9020 Des Moines, IA 50368 -9020 i..c TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301# NAME ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE t 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 t, sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of and agrees with the General Exemption .Statement at right and food or fiber, horticulture, aquaculture of floriculture for resale and /or uses the farm machinery, equipment or the applicable statement of the her agricultural production items purchased free of respective state printed on the reverse side of this form. tax, as defined by state law, and as indicated below. The undersigned 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 a Kentuck 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) 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 /Acluaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity 1 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 t o. Ingredient or Component Parts (KS) Other: CUSTO R SIGNATURE: (REQUIRED) MGR. APPROVAL X USE AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE 4 ITEM NUMBER DESCRIPTION Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY CO o P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS I I 11 CITY STATE ZIP PHONE 1, CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemptiori 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. reverse side of this form. PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they may be liable for payment of all taxes STATE: understand they Y P Y (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or Consumed In COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in 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 F Livestock Production Floriculture /Aquaculture Production law. Other. i L• 7 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injectibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt v Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X USE S1 YLYWHEN REGIS I ER IS INO PERATIVE CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER 'DESCRIPTIO h Lorm No. 99-00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR TRACTOR SUPPLY COMPANY off my cO P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE r• CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from I j' 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 reverse side of this form. tax, as defined by state law, and as indicated below. •y PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they may be liable for payment of all taxes STATE: understand they Y P Y (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other provisions as allowed under state Livestock Production Floriculture /Acluaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity [3 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: CUSTOMER SIGNATURE (REQUI ED) MGR. APPROVAL oZz� X SHA USE CASH CHECK VISA WC 'DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L3 U. ITEM I NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T PAYMENTS U TRACTOR SUPPLY COMPANY i7 sulpnyCO P.O. Box 9020 Des Moines, IA 50368 -9020 TSCTiEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME 00 1d 1. '1', "'T ADDRESS r31 CITY STATE ZIP PHONE CUSTOMER TO COMPLETE ?0, n" ;IT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 51�f,a:i','r I.If' 'A I I•' t, compliance with the agricultural payment of sales and use tax on tangible personal C ,r, y' dT 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 �i� I T1LII ,.i:• respective state printed on the other agricultural production items purchased free of tax, as defined by state law, and as indicated below. reverse side of this form. 1::1.'i' t PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they I rt STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by it (Exceptions: Georgia,,New York &Kentucky 7.J T E T t T COMPLETE REVERSE SOF) state law Should SUCK goo be used Or COnSLl In a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) IL1 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 t Agricultural Production F t 1't7 of exemption will cause the purchaser to be subject to Dairy penalty and /or other provisions as allowed under state Livestock Production Pr Flo riculture /A uaculture Production law. r A Other: 0 p, ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) r i I it Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity t i Fertilizer /Agrichemicais NC: only DOT and US Government are exempt 1 Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) I .t'_ d !i, .IJJ t, I Other: CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL a r _,:w FU L' X ONLY CASH CHECK ;M(C DISCOVER TSC CHARGE ACCOUNT NO. CHG• EXCH. DATE m ITEM NUMBER Form No. 99-00401 (12105) CUSTOMER ORIGINAL Hkivil I" fzk, dusliir- a A%;%,UU141 PAYMENTS TO: IV TRACTOR 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 NAME ADDRESS CITY STATE ZIP PHONE UAJI/�(;, l)"114 1 CUSTOMER TO COMPLETE 19 w,l!. i 14.; IJ 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. 00 1; S "i 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 1 i�b i t j -,ti 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 'N,) respective state printed on the tax, as defined by state law, and as indicated below. reverse side of this form. IJ I., PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in Lo COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) 1 —1, U t:. Z t J t t I L I o Lt ill J.t. Resale Under penalty of perjury, signee swears th0d Government information on this statement is true and correct in I .(11 U it ,1,1, i!1I 1 (.I- C] Exempt organization every material manner. A willfully false representatiori 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 FloriculturelAquaculture Production law. Other: 1 'a it Ci 0 k ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Iniestibles or Injectibles Exempt Organization (Entity Fertilizer/Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) a I.• L-. 1� 0 W1 W.1y •j::'. be Other: nr j, 4 I,I u ''i (!"•d) J cu TO MER SIGNATURE:(R F UIRF) MGR. APPROVAL X USE SHADED AREA ONLY WHEN REGISTER IS INO•ERATIVE. CASH CHECK VISA M/C DISCOVER A EA uN7 =N CHG. E XCH. Ll ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99-00401 (12/05) CUSTOMER ORIGINAL REM'IT TSC BUSINESS_ ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY S1� �Y co P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ,1 ADDRESS L CITY STATE ZIP PHONE �d(i L'. •:1(2 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 and agrees with the General engaged in the business of agricultural production of food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and t resale and /or uses the farm machinery, equipment or r t. the applicable statement of the other agricultural production items purchased free of respective state printed on the reverse side of this form, tax, as defined by state law, and as indicated below. PRODUCT ISM BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia New York a Kentucky state law should such goods be used or consumed in' COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) 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 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. „'i CUSTOMER SIGNATUR REQUIR D MGR. APPROVAL �G X CASH CHECK VISA °M /C DISCOVER TSC CHARGE ACCOUNT NO: CHG. EXCH. DATE LJ U L r Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T PAYMENTS TO: TRACTOR SUPPLY COMPANY V=FFLY P.O. Box Des Moineses, I A 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of and agrees with the General 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. reverse side of this form. 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 (Exceptions: Georgia New York a Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) 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 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: CUSTOMER SIGNATURE: (RE D) MGR. APPROVAL x USE SHADED AREA ONLY WHEN REGISTER IS IN CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER -DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 1r PAYMENTS TO: TRACTOR SUPPLY COMPANY SU y C® P.O. Box 9020 Des Moines, lA 50368 -9020 I TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of I r 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 reverse side of this form, tax, as defined by state law, and as indicated below. I PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or Consumed In COMPLETE REVERSE SIDE) tI ,i u C. i C i- a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) F1 Resale Under penalty of perjury, signee swears the iiI ii• a_I �..u[ i .i 1 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 purchaser to be subject to Dairy Production Livestock Production penalty and /or other provisions as allowed under state Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Q Farm Machinery/Repair Parts Government Agency (Entity Livestock- lnjestibles or Injectibles Exempt Organization (Entity E] Fertilizer/Ag rich emical s NO: only DOT and US Government are exempt Consumed i Production (KS) Resale (Sales Tax Permit Ingredient o Component Parts (KS) `f Other: CUSTOM R SI ATURE:(REQUIRED) MGR. APPROVAL X USE AREA',ONLY WHEN TWH CHECK. VISA M)C DISCOVER TSC CHARGE ACCOUNT NO: CHG. EXCH. DATE DE SCRIPTIOW 1 Form No. 99-00401(12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT �PAYMENTS TO: TRACTOR SUPPLY COMPANY SU'LY co P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is i 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 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 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. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production F 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 Injestibles or Injectibles Exempt Organization (Entity Fertilizer/Ag rich emicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) r a Other. CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL 1 X USE SHADED AREA ONLY WHEN REGISTER IS CASH CHECK VISA =DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS T0: TRACTOR SUPPLY COMPANY. SVVP,yC® P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield, IN 46074 6035-301 (317) 867 -3505 •NAME CARMEL STREET DEPT 3400 W 131ST ST .ADDRESS WESTFIELD IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 431 431000179 1 858859 07/18/2008 03:24pm CUSTOMER TO COMPLETE 3810470 JS PLIERS 16IN GRVJT 1.00 8 8.99 8.99 NT CERTIFICATE OF EXEMPTION GENERAL EXEMPTION STATEMENT: (WAS a 14.99) The undersigned certifies The undersigned party certifies their exemption from Government Agencies compliance with the agricultural payment of sales and use tax on tangible personal 3810470 JS PLIERS 16IN GRVJT sales tax exemption law of the state property as indicated below and /or purchaser is 1.00 L 8.99 8.99 NT indicated below and understands engaged in the business of agricultural production of (WAS e 14.99) and agrees with the General Government Agencies Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for resale and /or uses the farm machinery, equipment or the applicable statement of the Subtotal 17.98 respective state printed on the other agricultural production items purchased free of 7,00% Tax 0.00 reverse side of this form. tax, as defined by state law, and as indicated below. Total 17.98 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they TSC Card 17,98 STATE: understand the y ma y payment be liable for of all taxes Ac c t t: E s E E E E E E E E s E 6153 (REQUIRED). due on the purchase price for the goods as allowed by Au that 018998 Ref :1814240516 PO water truck (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. Chanse 0.00 PURCHASER IS ENGAGED IN: (REQUIRED) Cash Back Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct int d Buyer acknowledses the receipt of a comp le Exempt organization every material manner. A willfully false representation F1 Agricultural Production of exemption will cause the purchaser to be subject to COPY of this sales 51iP and the Purchase o F1 Dairy Production penalty and /or other provisions as allowed under state Livestock Production the described merchandise shall be in E) law Floriculture /AcluacultureProduction accordance with'the Cardholder Asreement, Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) S i 9n a f Ltr e Farm Machin ery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit 3Eiiiii Ingredient or Component Parts (KS) Call 800-968 -0734 within 7 days to F] Other: complete a survey and be entered in a nionthly drawins for a chance to win a CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL C ZJ X USE AREA o CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO, CHG. EXCH. DATE DESCRIPTION Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT iF T M PAYMENTS TO: TRACTOR SUPPLY COMPANY SU�YC® De Moines, A 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME L 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 r 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 respective state printed on the 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 STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by (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) 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 F Livestock Production L Floriculture /Aquaculture Production law. 1 Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) sale (Sales Tax Permit Ingredient or Com nent Parts (KS) Other: CUSTOME S NA RE:(REOUIRED) MGR. APPROVAL X IN USE SHADED AREA ONLY WHEN REGISTER CASH CHECK A M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTION UNIT P RICE Form No. 99 -00401 (12/05) 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 07/21/08 $350.49 07/21/08 $29.96 07/21/08 $335.04 07/21/08 $664.40 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 N ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $1,379.89 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department boy- PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 2201-670.99 $350.49 1 hereby certify that the attached invoice(s), or 2201 43- 560.01 $29.96 bill(s) is (are) true and correct and that the 2201 42- 389.00 $335.04 materials or services itemized thereon for 2201 42- 370.00 $664.40 which charge is made were ordered and received except Thursday, July 31, 2008 w Street CoWissioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund