Loading...
HomeMy WebLinkAbout176958 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 t ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $284.97 CARMEL, INDIANA 46032 PO BOX 689020 DES MOINES IA 50368 -9020 CHECK NUMBER: 176958 *on CHECK DATE: 9/2/2009 DEPARTM ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESC RIPTION 2201 4467099 STREET 284.97 6035301200050860 page 1 of 3 7x TOR j SUPPLYCO2 BUSINESS ACCOUNT AGGQUNIT S�lAM�IR a e Previous Balance 61.28 Closing Date 08/19/09 Payments 39.27 Next Closing Date 09/18/09 CARMEL STREET DEPT Credits 100.00 Payment Due Date 09/13/09 CINDY Purchases 384.97 3400 W 131 ST ST Debits 0.00 Current Due 284.97 WESTFIELD, IN 46074 -8267 FINANCE CHARGES 0.00 Past. Due Amount 22.01 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 306.98 Credit Available 4,929 New Balance 306.98 CURRENT ACTIVITY Tratraaaciton t Locations r Am nt MN mate I�sscrlptigna JUL-21 GOODS AND SERVICES WESTFIELD IN 324.98 JUL 21 GOODS AND SERVICES NOBLESVILLE IN 59.99 JUL 22 GOODS AND SERVICES WESTFIELD IN CREDIT 100.00 TOTAL 6035301200074795 $284.97 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS JUL 23 PAYMENT REF P9194006Q09EXDW3D 39.27 Did you overlook your payment to us? If so, please send the amount due today. If payment is in the mail thank you! FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Dally Days in ANNUAL Subject to Periodic Billing PERCENTAGE subject to Periodic ailing PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 29 0100 0.00 .00000 33 0.00 This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1-800-559-8232 FAX NUMBER 1 -801- 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 staterent. We must hear from you in writing no later than 50 days after we Payment Options Other Than Regular Mail: sent you the first statement on which the error or problem appeared. In your letter, give us the following information: Pay by Phone. You may make your payment by phone by using the Pay by Phone Service. You will be charged $14.95 to use this payment service. Your name and account number. Call by 5 p.m. Eastern time to have your payment credited as of that day. The dollar amount of the suspected error. If you call after that time, your payment will be credited as of the next day. Describe the error and explain, if you can, why you believe there is an We may process your payment electronically upon verification of your error. If you need more information, describe the item you are unsure identity. abort. Send payment by courier or express mail to the Express Payments address: Customer Service Center, Dept. CGS 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 cr 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 3 r ��4 SIIPPLYC! BUSINESS ACCOUNT CURRENT ACTIVITY Trar cticsn Al L�tcallon %r z t8 �riptio ArR©uit This account is subject to the Alternate Balance Subject to Finance Charge Calculation Method. See back for details. 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 $5.003 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 rn iy 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 S 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. Fulf Balance S902TV 10/06 902TV5741006 PCT rr, NURWM M BUSINESS ACCOUNT Remit To: Bill To: page 3 of 3 1093 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 )V DEPT.30 1200050860 RON WILLIAMS VV__ PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 Payment Due Date: 09/13/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 624001167524010 431000950087010 Purchase Order: Purchase Order: NEWTRUCK NEWTRUCK AMOUNT DUE: 59.99 AMOUNT DUE: 324.98 store: 574000624 INVOICE DATE: 07121 /09 Store: 574000431 INVOICE DATE: 07121 /09 BED MAT BFT FORD 250 35 0184901 1.00 59.99 59.99 TBX BET ALUM FS BK SGL 1091737 1.00 299.99 299.99 FLOORMATS BLACK 1342049 1.00 24.99 24.99 SUBTOTAL 59.99 TAX 0.00 SUBTOTAL 324.98 SHIPPING 0.00 TAX 0100 SHIPPING 0.00 TOTAL 59.99 TOTAL 324.98 SHIP TO: INVOICE: 431000950436010 AMOUNT DUE: 100.00 Store: 574000431 INVOICE DATE: 07122 /09 TBX BET ALUM FS BK SGL 1091737 1.00 299.99 299.99 TBX BET ALUM FS SGL LP 1091711 1.00 199.99 199.99 SUBTOTAL 499.98 SHIPPING 0.00 TOTAL 100.00 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425 r 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 tee for each duplicate statement for a billing period that If you think your bilWig 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 statear,ent. We rnusY 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 ji4.95 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. Q 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 LS so Z5 \J BUSINESS ACCOUNT REMIT TSC BUSINESS ACCOUNT a Tm 7OR® PAYMENTS TO: TRACTOR SUPPLY COMPANY SU Y C� P.O. Box 9020 Tractor Supply Company M Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield, IN 46074 6035 301 317) 867-3505 NAME CARMEL STREET DEPT S400 W 131ST ST ADLLRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000182 2 950087 07/21/2009 10:45api CUSTOMER TO COMPLETE 1091737 TBX BET A LUM FS BK S 1.00 LJ 299,99 2 99,99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from 1 S4'2049 FLOORMATS BLACK compliance with the agricultural payment of sales and use tax on tangible personal 1.00 24.99 24.99 NT sales tax exemption law of the state property as indicated below and /or purchaser is Gover Asencies indicated below and understands engaged in the business of agricultural production of and agrees with the General Subtotal 324.913 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00% Tax 0.00 the applicable statement of the Total 324.98 respective state printed on the other agricultural production items purchased free of. TSC Card 324.90 reverse side of this form. tax, as defined by state law, and as indicated below. Acc t J T E T T E t J J J J T4795 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Auth #:021569 Reft: ;2109445387 understand the may be liable for payment of all taxes PO NEW TRUCK STATE: y y p y CI'la f 19f_' Q, QQ (REQUIRED) due on the purchase price for the goods as allowed by Cash Back (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. Buyer acknowledses the receipt of a coniple PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in copy of this sales slip and the Purchase o Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to the described merchandise shall be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder A3reew n t. Livestock Production Floriculture /Aquaculture Production law. Other: Sisnature: 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 SJTTTJEEJJJEEJtTJTETEJETTETiJTEEJTEE3 Consumed in Production (KS) Resale (Sales Tax Permit Call 800 -968 -0734 within 7 days to Ingredient or Component Parts (KS) complete a survey and be entered in a monthly drawins for a chance to wits a Other: 42500 shopping spree. (Awarded as Gift Card) NO PURCHASE CUST I URI -(R IRED) MGR. APPROVAL 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 ARKANSAS: Tho CnSlomor, as indicated by their signature on the reverse. certifies that he /she is engaged in the business nl farming and the farm machinery and equipment purchase] will be used exclusively and directly in the agricultural production of food or fiber as business. The reverse signed is aware that any false reprex tation made by then, in an attempt In purchase farm machinery and equipment free from Arkansas Sales Tax is a misdemeanor. GEORGIA: The reverse signed hereby cenifics that all tangible personal property purchased or leased after the revers. indicated date will be purchased or leased for the purpose indicated bnI0 unless otherwise specified on a particular order, and that the purchases are used as a part of a pursuit engaged in lot profit. This certificate shall remain in effect until revoked ill writing. Any tangible personal property obtained under this certificate of exemption is subject to the sales and use tax if it is used or consumed by the purchaser in any manner other than i on this certificate. (Check proper box.) -FARM MACHINERY AND EQUIPMENT- 1 Rubber -ilr.d farm tractors and attachments which will be used exclusively in lilting, planting, cultivating or harvesting farm crops for sale. Such crops will be planted and harvested within a twelve -month period. O.C.G.A. 48 -8- 3(29)(1) 2. Machinery and/or equipment which will be used on the farm directly in the production of poultry or eggs for sale. O.C_G.A. 48- 8- 3(29)(A) 3., Machinery and /or equipment which will be used on the farm directly in the production, processing or storage of fluid milk for sale. O.C.G.A. 48- 8- 3(29)(C) Machinery a.nc /or equipment which will be used on the farm directly in the production of livestock for sale. O.C.G.A. 48- 8- 3(29)(D) S. Machinery and%or equipment which will be used on the farm directly in harvesting farm crops grown and used on the farm as feed for poultry or livestock by a producer falling under the categories 2, 3. or 4 above. O.C.G.A. 48- 8- 3(29)(E) 6. Machinery and/or equipment which will be used in the hatching and breeding of poultry and livestock for sale. O.C.G.A. 48- 8- 3(29)(13) 7. Machinery and /or equipment which will be used in tilling the soil or in animal husbandry. O.C.G.A. 48- 8- 3(29)(F).(G) (H) 8. Machinery and/o r equipment which will be used exclusively for irrigation of farm crops grown for sale including, but not limited to fruit, vegetable and nut crops. O. C.G.A.§ 48 -8 -3(26) 9. P.can sprayers, paean shakers and/or other equipment used in harvesting pecans. O.C.G.A. 48- 8- 3(29)(J) _quip -it which will be used on the farm exclusively in processing onions. O.C.G.A. 48 TIMBER EQUIPMENT AND RELATED ATTACHMENTS- equipment and related attachments which will be used exclusively in the site preparation, planting, cultivation, or harvesting of limber. This shall include all of/ -road oquipmonl and related allachmonts used in every forestry procedure starling with the severing of a tree from the ground until and including the point at which the tree or its parts in any tor— has been loaded in the field in or on at truck or other vehicle for transport to the place of use. O.C.G.A. 48-8-3(29),1) LIVESTOCK, SEED, FERTILIZER, FEED, PACKAGING, ETC.- 12. Cattle. hogs, sheep, horses, poultry, and bees when sold for breeding purposes. O.C_G.A. 48 -8 -3(28) 13. Seed, seedlings, fertilizers, insecticides, fungicides, rodenticides. herbicides, defoliants, soil fumigants, plant growth regulating chemicals. desiccants (including shavings and sawdust from wood, peanut hulls. fuller's earth, straw and hay) and food for livestock, fish or poultry when used either directly in tilling the soil or in animal, fist', or poultry husbandry: and /or, nonreturnable materials used for packing farm products for shipment or sale. O.C.G.A. 48 -8 -3(25) (35) (A) (iii) -FUELS USED IN POULTRY STRUCTURES ELECTRICITY USED IN IRRIGATION OF FARM CROPS- 14. The sale of electricity for the operation of an irrigation system which is used on a farm exclusively for irrigation of farm crops when separately metered. O.C.G.A. 48 -8 -3(64) 15. Liquefied petroleum gas or other fuel used in a structure in which broilers. pullots- or other poultry are raised when separately motored. O.C.G.A. 48 -8 -3(49) ILLINOIS: The reverse signed hereby certifies that the property purchased will be used primarily in production agriculture or in State or Federal agriculture programs. Any faun chemicals purchased as erompt are such pursuant to Section 130.1955. KENTUCKY: The reverse signecl hereby certifies that they are a farmer regularly engaged in the occupation of: (farmer must Initial appropriate [Instal) tilling and cultivating the soil for the production of crops: raising and feeding livestock or poultry the products of which ordinarily constitute food for human consumption; or raising and feeding• Iiarnas, alpacas, ratites, buffalo, or aquatic organisms. The reverse signed aIse•Cerlifies that the tangible personal property purchased as indicated below will be used for the exempt purpose(s) provided for under KRS 139.480. Farmer must INITIAL appropriate line(.). Baling twine and wire Farm chemicals r Farm machinery, attachments and repair /replacement parts therefor Farm work stock Feed and feed additives Gasoline, special fuels, nafutal gas or liquefied petroleum gas Livestock or poultry the products of which ordinarily constitute food for hurnan consumption Ratites, llamas, alpacas, buffalo, or aquatic organisms Machinery, equipment, attachments and repair /replacement pans therefor to be incorporated into an existing on -farm grain /soybean f.cilityrand.poultry, livestock, ratite, llama, alpaca. or aquaculture facilities' Seed or fertilizer Materials to be incorporated into the renovation or repair of an existing on -farm grain /soybean facilities and poultry, livestock, ratite, llama, alpaca, or aquaculture facility. Water used in the production of crops as a business or in the raising of livestock /poultry, ratites. llamas, alpacas. buffalo, aquatic organisms and dairy cattle. SF_F_ REVERSE SIDE SEE REVERSE SIDE_ Signature Date MICHIGAN: The reverse signed hereby certifies that all items, except as indicated, are purchased for use or consumption in connection with the production of horticultural or agricultural products as a business enterprise, and agrees to reimburse the sailer the sales tax if used or consumed otherwise. Unlawful use of this certificate subjects persons to the penalties of the sales to act. NORTH DAKOTA, SOUTH DAKOTA: The purchases made herein are subject to the reduced rate of sales tax and are not exempt from such tax. NEBRASKA: The reverse signed certifies the intended use of the items purchased renders it exempt under Reg. 1 -060, 1 -061 or 1 -063. TEXAS CERTIFICATION OF EXEMPTION Purchaser's name SEE REVERSE SIDE Street Address SPE REVERSE City, state, zip code SEE RF_VF_RSE SIDE I claim an exemption from payment of sales and use taxes /or the purchase of taxable items described below or on the attached order or invoice: SEE REVERSE SIDE Description of items (or an attached order or invoice) [o be punch...d: SEE REVERSE SIDE I claim this exemption for the following reason: SEC- REVERSE SIDE I understand that I will be liable for payment of sales tax which may become due for failure to comply with the provisions of the Tax Code: Limited Sales, Excise. and Use Tax Act, Municipal Sales and Use Tax Act, Sales and Use Taxes for Special Purpose Taxing Authorities. County Sales and Use Tax Act. County Health Services Sales and Use Tax and the Texas Health and Safety Code: Special Provisions Relating to Hospital Districts, Emergency Services Districts, and Emergency Services Districts in counties with a population of 125, 000 or less. Liability for the tax will be determined by the price paid for the taxable items purchased or the fair market rental value for the period of time used. 1 understand that it is a criminal offense to give an exemption certificate to the seller for taxable items which I know, at the time of purchase, will be used in a manner other than that expressed in this certificate. Seller: SEE REVERSE SIDE Street address: SEE REVERSE SIDE City. state, zip code: SEE REVERSE SIDE Purchaser's signature: SEE REVERSE_ SIDE Date: Phone: Title: SEE REVERSE_ SDF_ This certificate does not require a number to be valid. Sales and use tax exemption numbers or tax exempt numbers do not exist. This certificate should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public Accounts. Effective Date: September 10, 1991 Rule 3.287 NEW YORK STATE DEPARTMENT OF TAXATION AND FINANCE NEW YORK STATE AND LOCAL SALES AND USE TAX, FARMER'S EXEMPTION CERTIFICATE To purchasers and sellers: To be completed by the fanner, given to and retained by the seller. To have a valid certificate, all entries must be completed. Read all instructions caret ully.betore completing or accepting this certificate. To sellers: You may not accept this certificate as the basis for selling exempt from tax the property or services listed below. Tax must be collected on such sales. This certificate may not be used to claim exemption for the following: 1. utilities, fuel oil, motor fuel or diesel fuel; 2. labor charges in connection with repair, maintenance of or service to real property: 3. tangible personal property incorporated into a building, structure, silo foundation or other capital improvements to real property (excluding grape trellises and the remaining portions of a silo); 4: rnotor vehicles; or 5. property listed as taxable. Name of seller TRACTOR SUPPLY COMPANY AFFILIATES Attn: Tax Name of Farmer SEE_ REVERSE SIDE Street address 200 Powell Place Street address SEE REVERSE SIDE City Bre State TN ZIP Code 37027 City SEE REVERSE_ SIDE State ZIP Code Chock applicable box: [E1 Single Purchase Certificate F Blanket Certificate I, the reverse signed hereby certify that I am exempt from payment of the sales and use tax on tangible personal property purchased from you because the property is to be used for art exempt purpose and that certain services are also exempt when performed on an exempt property. (Check applicable box or boxes.; CI (a) Tangible personal property, except property Incorporated into a building or structure, for use or consumption directly and predominately In the production of tangible personal property for sale by farming, including stock, dairy, poultry, fruit, fur bearing animal, and truck farming. The term farming also Includes ranching, operating nurseries, greenhouses or other similar structures used primarily for the raising of agricultural, horticultural or floricultural commodities, and operating orchards or vineyards. I (h) Tangible personal property for use In erecting, adding to, altering or Improving a silo used in forming to make and stbre silage on a farm, provided such tangible personal property is to become an integral component part of such silo. (This exemption does not apply to tangible personal property used in constructing a silo foundation.) O (c) Posts and wire for use in constructing or maintaining vineyard trellises used in growing grapes for sale. I 1 (d) Services of Installing, repairing, maintaining and servicing exempt tangible personal property. (This exemption Is provided for both state and local sales and use lax with the exception of the tax imposed by or for New York City.) 'I'hes& statements are made with the knowledge that willfully issuing a false or fraudulent certificate with the intent to evade tax is a misdemeanor under ...lion 1817( of the New York State Tax Law and section 210.45 of the penal law punishable by a fine of not more than $1,000, or imprisonment for not more than a year or both. Signature of farmer or farmer's representative (state title and relationship) SEE REVERSE SIDE Date Seller The tax exemption for farmers is limited to the purchases of (1) tangible personal property used directly and predominantly in the production phase of farming and (2) the services described in (d) related to that property. Purchases for use in administration. storage or marketing or purchases of tangible personal property used indirectly in farming would not qualify. (See Publication 844, Sales Tax Information for Farmers, for a complete explanation of the tax treatment of farmers purchases and sales.) For your protection, a farmer must give you this certificate not later than 90 days after delivery of the property sold or services rendered. If you have not received this certificate within 90 days of the date of sale, the sale will be deemed to have been taxable at the time the transaction took place and the burden of proving it was not, shall be upon both you and the purchaser. If the blanket certificate box is chocked, you may consider this certificate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives you written notice of revocation, or until the Tax Department notifies you that the purchaser may not make exempt purchases. Purchaser You must pay tax on utilities (telephone. telegraph, electricity or gas service) heating oil, motor fuel and.diesell motor fuel at the time of purchase and claim a refund for any exe rapt use. (If you are purchasing diesel motor fuel for exclusive consumption in farm machinery used to produce tangible personal property for sale, you may use Form FT -1004. Farmers Exemption Certificate for Purchases of Diesel Motor Fuel to purchase that fuel exempt.) If the blanket certificate box is checked, you may consider this certificate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives you written notic. of revocation, or until the Tax Department notifies you that the purchaser may not make exempt purchases. REMITTSC BUSINESS ACCOUNT PAYMENTS TO: IF TRACTOR AC SUPPLY COMPANY S P.O. Box 9020 Des Moines, IA 50368 -9020 Tra U,S 3 C o m pany 18160 U.S. 31 Nc�rt'rl TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield, IN 46074 6035 301# (317) 867 -3505 NAME CARf4EL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431 000183 2 950436 07/22/2009 02:17pm CUSTOMER TO COMPLETE 1091737 TBX BET ALUM FS BK S 00 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 Go e 2/99. 299.94' NT vernment Agencies The undersigned certifies The undersigned party certifies their exemption from 1091711 TSX SET ALUM FS SGI_ compliance with the agricultural payment of sales and use tax on tangible personal 1.00 a 199.99 199.99 TAT sales tax exemption law of the state property as indicated below and /or purchaser is WAS l? 26439 indicated below and understands engaged in the business of agricultural production of Government A9etrcie5 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 Subtotal 100.00 the applicable statement of the 7,00: 'fax 0,00 respective state printed on the other agricultural production items purchased free of Total 100.00 reverse side of this form. tax, as defined by state law, and as indicated below. TSC Card 100.00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Acct *:t33 #333tEtt34795 understand the be liable for payment of all taxes Auth* Ref STATE: y may a p y Chanse (REQUIRED) due on the purchase price for the goods as allowed by 0.00 (Exceptions: Georgia, New York Kentucky State law Should Such goods be used or consumed In Lash Back COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Buyer racknawled9e5 the receipt of a coriple r7 Resale Under penalty of perjury, signee swears the d Government information on this statement is true and correct in copy of this sales slip and the Purchase o Exempt organization every material manner. A willfully false representatio Agricultural Production of exemption will cause the purchaser to be subject to the described merchandise shall be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Agreemen Livestock Production Floriculture /Aquaculture Production law. Other: Signature: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) F Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt fi3tY3Ei ;EEt3tYEEE #3 #3E3Y ;YYiE;Y3E 3t; 3tt332t333 ;Y3 ;;YYi ;YYYY #3' Consumed in Production (KS) Resale (Sales Tax Permit Call 1300-968 within 7 flays t0 Ingredient or Component Parts (KS) complete a survey and be entered in a m drawing for a chance to win a other: $2500 shoppins spree. (Awarded as Gift Card) NO PURCHASE CUSTO I ATURE:(R U ED) MGR.APPR yr AREA "'&sWHEN REGISTER IS INOPERATIVE. CrrAA�SH CHECK VISA M/C DISCOVER T CHG. EXCH, DATIn L.1 I I I I I I I I I ITEM NUMBER DESCRIPTIO Form No. 99- 00401 (12/05) CUSTOMER ORIGINAL ARKANSAS -fha Customer, as indicated by illicit signature on the reverse. certifies that he /She is engaged in the business of farming and t farm machinery and equipment purchase[) will be used ...iusivcry and directly in tire agricuitu rat protluctian of food or fiber' as a business. The reverse signed is a an. that any false eprasenta tin made by then, in ,n attempt purchase farm machinery and equipment tree from Arkan a s Sales Tax is a rn isdem ea npr. GEORGIA; The reverse signed hereby certifies that all tangible personal property purchased or leased after tike reverse indicated data will be purchased or leased for the purpose rndicaled bar.,,- unless otherwise specified on a particular order, an r d that the purchases are used as a part of a pursuit engaged in for profit. Tlsis certilical. shalt remain effect. until vokad Ir writing. Any tangible personal property pblained under [his certificate of exemption is subject to file sales and use tax if it is used or consumed by the p.rchaser in any matt..... other than indicated on this certificate. (Check proper box,) -FARM MACHINERY AND EQUIPMENT- 1, Rubber-tired farm tractors and al1a hm tS which will be used exclusively fn tilling, planting. cultivating ar harvesting farm crops for sale. Such crops will be planted and harvested -Rhin a twelve-month period_ O.C,G.A. 48- 8- 3(29)(1) Machinery and /or equipment which will be used on 1ha fang, directly in the production at poultry or eggs for sale- O_C.G_A_ 48- 8- 3(29)(A) :S. Machinery and /or equipment which will be used on the fann directly in the production, processing or storage of fluid milk for sale. O- C.G.A. 48 J 4, Machinery and: pr' equip... nt which will be used on the farm directly in the production of livestock far sate. O.C.G.A. 48- 8- 3(29)(D) 5 Machinery and %or equipment which will be used on the farm directly in halting farm crops grown and used on the farm as feed for poultry or livestock by a producer failing under the ..toga vies 2, 3. ar 4 above. O. C. e G.A. G. A, 48- 8- 3(29)(E) J 6. Machinery and"' equipment which will be used in the hatching and breeding of poultry and livestock for sale. O.G.G_A. 48- 8- 3(29)(6) 7 Machinery and/or equipment which will be used in tilling the soil or in animal husbandry. O.C.G.A, 48- 8- 3(29)(E)_(G) S (W) 8. Machinery and /or equipment which will be used exclusively for irrigation of faarm crops grown for sale including. but not hmiled to fruit, vegetable and nut crops. O,C,G -A.§ 48 -8 -3(26) 1 J 9 Peen sprayers, pecan shakers and /or other equipment used in harvesting pecans. CrC.G,A. 48- 8- 3(29)(J) I 10. Equipnient which will he used on ilia farm exclusively In processing anions, O.C.G.A. 48-8 3(29)(1) TIMBER EQUIPMENT AND RELATED ATTACHMENTS- 11. Off -road equipment and related attachments which will be used exclusively in the site preparation, planting, cultivation, or harvesting of timber- This shall include all oft -road oquiprn o-nt arid related attachments used in every forestry procedure starting with the severing of a tree Tram the ground until and including the point at which trio Irce or its parts in any form has been loaded in the Fie in or o., a truck or other vehicle for transport to file place of use. O.C.G.A. 48 8 3(29).1) LI VESTOCK, SEED, FERTILIZER, FEED, PACKAGING, ETC: 12, Oattle, hogs, sheep, horses, poultry, and bees when sold for breeding purposes. O.C.G.A. 48- 8 -3(2a) 13. Seed, seedlings, fertilizers, insecticides, fungicides, rodenticides, herbicides, defoliants, soil fumigants, plant growth regulating chenhicals, dosiccants (including shavings and sawdust from wood, peanut hu115, fuller's earth, straw and hay) and feed for livestock, fish or poultry when .sad either directly in tilling the soil or in animal, fish or poultry husbandry. and /or, nonreturnable materials used for packing farm products for shipment or sale. O.C'G.A. 48 -8- 3(25) (35) (A) (iii) -FUELS USED IN POULTRY STRUCTURES ELECTRICITY USED IN IRRIGATION OF FARM CROPS J 14. The sal. of elect icily for the operation of an irrigation system which is used on a farm exclusively far irrigation of farm crops when separately metered. O.C.G.A. 48 -8 -3(64) 15. Liquefied palrolcum gas or other fuel used in a structure in which broilers, pullets, or other poultry are raised when separately metered. O.C.G.A. 48 -8 -3(49) It- l,INOrS The reverse signed hereby certifies that the property, purchased will be used e primarily irh production agricultur or in State or Federal agriculture programs. Any farm chemicals purchased as exempt are -such pursuanf to Secifon 130.1955. I KENTUCKY- The reverse signed hereby certifies that they are a farmer ragularly the occupation of; (farmer must'initial appropriate fine(.)) _,__lflling and cultivating the soil for the production at crops: raising and feeding livestock or poultry the products of which Ordinarily Conattiule. food fo'r' human Consur'npfion; or raising and feeding llamas, alpacas, ratites, buffalo, or aquatic orgare rns. The reverse signed also certifies that the tangible personal property purchased as indlcated will be used for trio exempt purpere(s) provided for under KRS 139.480. Farmer must INITIAL appropriate If..($)- ,r J,f' t Baling twine and wire 4 t Farm chemicals '00 "01— Farm machinery, attachments and repair /replacement parts therefor _Farm work stock ref r,f �',�i it C. Feed and feed additives 1 r Gasoline, special fuels, natural gas or liquefied petroleum gas Livestock or poultry the products of which ordinarily constitute food for human consumption l�zatitar, ftarrtas, alpars5, buffalo, or aquatic organisms Machinery, equipment, attachments and repair/replacemanl parts therefor to be incorporated into an existing on -farm gm)nfsoybe "anrfacility find poultry; livestock, ratite, llama, alpaca, or aquaculture facilities Sear] or fertilizer t i S Materials to be incorporated into the renovation or repair of an axisting on farm graln /soybean facilities and poultry, livestock, ratite, llama, alpaca, or aquaculture facility. Water used in the production of crops as a business or in the raising of livestock /poultry, ratites, llamas, alpacas. buffalo, aquatic organisms and dairy cattle. SEE_ REVERSE SI SEE REVERSE SIDE Signature Date MICHIGAN: The reverse signed hereby certifies that all items, except as indicated, are pur'ahasad for use or consumption in Connection with the production of horticultural or agricultural products as a business enterprise, and agrees to reimburse the seller the sales tax if used or consumed otherwise, Unlawfur use of this certificate subjects persons to the peilatfies of the sales is act. NORTH DAKOTA, SOUTH DAKOTA: The purchases made heroin are subject to the reduced rate of sales tax and are not exempt from such tax. NEBRASKA- The reverse signed certifies the intended use of the items purchased renders it exempt under Reg. 1 -060, 1 -061 or 1-053 TEXAS CERTIFICATION OF EXEMPTION Purchaser's n� 1 SEE REVERSE SIDE Street Adde rss 5EE REVERSE SIDE City, slate, zip code _E REVERSE IDF_ I claim an exemption from payment of sales and use taxes for the purchase of taxable items described below or on the attached order or invaic SEE REVERSE SIDE Description of items (or an attached order or invoice) to be purchased: SEC REVERSE SIDE I 1 claim this exemption for the following reason: SEE REVERSE SIDE I understand that I will be liable IF r payment of .alas tax which may become due for failure io comply with the provisions of the -Tax Code: Limited Sales, Exci §e, and U e ''I "ax Act, Municipal Sa €es and Us. Tax Act, Sales and Use Ta x.. for Special Purpose Taxing Authorities, County Sa los and Use lax Act, County Health Services S.I.c and Us. Tax and the Texas Health and Safety Code: Special Provisions Relating to Hospital Districts. Emergency Services Districts, and Emergency Services Districts in counties with a population of 125, 000 or I.ss. Liability for the tax will be determined by the price paid for the taxable items purchased or the fair market rental value for.mr, period of tuna used. 1 understand that it is a criminal offense to give an exemption certificate to the seller for taxable items which I know, at the time of purchase, will be used in a manner other than that axpressect in this cartilicafe. f Seiler- SEE REVERSE SIDE Street address: SEE REVERSE SIDE City, slate, zip code, SEE 9EVER'+F CIDF Purchaser's signature. 5EE REVERSE SIDE_ Dale: Phone- t Title: SFF REVF_R F SIDE i This Certificate does riot require a number to be valid. Sales and use tax exemption numbers or tax exempt nurnbers do not exist. This certificate should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public Accounts. Eftective Date Sptember 10, '1991 I Rule 3.287 NEW YORK STATE DEPARTMENT OF TAXATION AND FINANCE NEW YORK STATE AND LOCAL SALES AND USE TAX. FARMER'S EXEMPTION CERTIFICATE To p. and sellers: To be completed by the farmer, given to and retained by the seller. To have a valid certificate, all entries must be completed. Read all instructions carefully before completing or accepting this certificate. To sellers: You may not accept this certificate as the basis for selling exempt from tax the property or services listed below. fax must be collect ©d on such sales. This C.rtificala ..'ray not be oSErd to Clain. exemption for fhe following 1. 1 utilities, fuel oil. motor fuel ar diesel fuel; 2. labor charges in connection with repair, maintenance of or service to real property: 3. tarAgibie personal properly incorporated into a building, structure. silo I dation or other capital im o m prveents to real property (excluding grape trellises and the remaining portions of silo): 4. motor vehlcies; 01 5. property listed as taa e. xbl Name of seller TRACTOR SUPPLY COMPANY AFFILIATES Attm Tax Name of Farmer SER REVERSE SIDE a Street address 200 Powell Place Street address EE RSV RS�E city f3ren[wood „___Stale.,, TN ZIP Code 37027 City____S F..VF_R S F_ ,I State LIP Code Chock applicable box: Ll Single Purchase Certificate C Blanket Certificate I, the reverse signed hereby certify that I am exempt from payrnont of the sares and use tax on tangible personal property purchased from you because the property is 1. be used for an exempt purpose and that certain services are also exempt when performed on an exempt property. tOheck applicable box or boxes.) CI (a) Tangible personal property, except property incorporated Into a building or structure, for use or consumption directly and predominately In the production of tangible personal property for sale by farming, including stock, dairy, poultry, fruit, fur bearing animal, and truck farming. The 'term farming also includes ranching, operating nurseries, greenhouses or other similar structures used primarily for the raising of agricultural, horticultural or floricultural commodities, and operating orchards or vineyards. 1 [_3 (b) Tangi tire personal properly for use In erecting, adding to, altering or Improving a silo used In farming to make and store silage on a farm, provided such tangible persona[ property Is to become an integral component part of such silo. (This exemption does not apply to tangible personal properly used in constructing a silo foundation IJ (c) Pasts and wire for u nstructing Or maintaining vineyard trellises used In growing grapes for sale. F1 (01) Services of installing, repairing, maintaining and servicing exempt tangible personal property. (This exemption is provided for bath state and local sales and use tax with the exception of the tax Imposed by of for New York Clty.) I These statements are made with the knowledge that willfully issuing a false or fraudulent certificate with the intent to evade 'tax is,a misdomea nor under section 181 T {m) of the New York State Tax I_aw and section 21(),45 of the pedal law punishable by a fine of not more than $1,000, or Imprisonment for not more than a year or both. Signature of farmer or farmer's representative (state title and relationship) SEE REVERSE SIDE Date Seller The tax exemption for farmers is limited to the purchases of (1) tangible personal property used directly and predominantly in the production phase of farming and (2) the services described in (d) related to that property. Purchases for use in administration, storage or marketing or purchases of tangible personal property used indirectly in farming would not qualify. (Sea Publicafion 844, 5algs Tax ,for natipn for rar e,s, for a complete explanation of the tax treatment of farn'iers purchases and sales.) For your protection, a farmer must give you this certificate not later than 90 days after delivery of the property sold or services ronderod. If you have not received this cenNicate within 90 days of the data of sale, the sale will be doomed to have been taxable at 1ho tuna the transaction took place and the burden of proving it was not, shall be upon both you and the purchaser. It the blanket certificate box is checked, you may consider this certificale part of any order received from the purchaser. A blanket certificate rernains in force until the purchaser gives you written notice of revocation, or until the Tax Department notifies you that the purchaser may not make exempt purchases. Purcbaser You must pay tax on utilities (telephone. telegraph, erectrieity or gas service) heating oil, motor fuel and di...]-motor fuel at the little of purchase and claim a refund for any exempt use. (If you are purchasing diesel motor fuel for exclusive consumption in farm machinery used to produce tangible personal property for sale, you may use Form FT -1004, F vr'n're) S ExE fo/ of Diesel Molor' FGBI t0 purchase that fuel exempt.) It the blanker certificate box is checked, you may consider this certificate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives YOU wr'ilfell notice till rove Cation, or until the T. x Department notifies you that the purchase ..lay riot make exempt P',rchas.s_ REMIT TSC BUSINESS ACCOUNT IVTRW PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY au�Y CO P.O. Box 689020 Tractor Supply C010Panv Des Moines, IA 50368 2375 East Pleasant St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville. IN 46060 6035 301 317) 776 1883 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 624 624000104 2 1167524 07/21/2009 02:24pm CUSTOMER TO COMPLETE 0184901 BED MAT 8FT FORD 250 00 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1. Go a 59.99 59.99 NT 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 59.99 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00% Tax 0100 indicated below and understands engaged in the business of agricultural production of Total 59.99 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card 59.99 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct fffaEaEffEff4795 the applicable statement of the other agricultural production items purchased free of Auth *:021396 Ref *:2113240464 respective state printed on the tax, as defined by state law, and as indicated below. PO new truck reverse side of this form. 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 by Buyer acknowledses the receipt of a comple (Exceptions: Georgia, New York Kentucky state law Should such goods be used Or consumed irtt d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy Of this sales slip and the Purchase o PURCHASER IS ENGAGED IN: (REQUIRED) f Resale Under penalty of perjury, signee swears the the described merchandise shall be in 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 Sisnature: Livestock Production Floriculture /Aquaculture Production IdW. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity ffififafifEEffaffifffaiifEfEfEfEfifaY 2fffiiEfafffEEffffiffEfif lffififEEEii Livestock Injestibles or Injectibles Exempt Organization (Entity Call 800- 968 -0734 within 7 days to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a Consumed in Production (KS) Resale (Sales Tax Permit monthly drawins for a chance to win a 82500 shoppins spree. p Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE Other: OR SURVEY NECESSARY. Ends 9/30/09, COST URE: (REOUI D MGR. APPROVAL L X USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL ARKANSAS T'he c istorncr as indicated by their signature on the reverse, certifies that I--h. is .rigagetl in the business at farming and the farm n rch'nery and equipment purchased will ba usa;d er :elusively a td diree.fly in the agricultural production of food or fiber as a business The reverse signed is aware that any false rerpresentatron made by them in an attempt to purchases farm n orlriIt. y and egriprnent free from Arkitnsas Sales Tax is i$denteanor. GE 1 e RGIA. Pi r signed hereby carte ies that all tangible personal property purchased or leased after the reverse indicated date will be purchased or leased for the purpose _1_11d below unless olh erw'S. specified on a particular order, and that the purchases are used as a part of a pursuit engaged In for profit. Phis certificate shall remain in affect until veked rr 1, tong. Any tangible personal properly obtained under this certificate of exemption is subject 10 tire sales and use tax if it is used or consumed by the purchaser In any rto, .'tier than vindicated on this certificate. (Check proper box.) -FARM MACHINERY AND EQUIPMENT- J 1 Rubber -tired farm tractors and attachments which will be used exclusively in tilling, planting. cultivating or harvesting farm crops for sale. Such crops will be planted :I harvested within a twelves -month period. O.C.G.A. 48 -8- 3(29)(1) 2. Machinery and /or equipment which will be used on the larva directly in the production of poultry or eggs for sale. O.C.G .A. 48- 8- 3(29)(A) 9. Machinery and' equipment which will be used on the farm directly in the production, processing or storage of fluid milk for sale. O.C.G.A- 48- 8- 3(29)(C) J 4 Machinery and /or equipment which will be used on the farm directly In the production of livestock for sale. O.0 48 8 3(29)(D) j Machinery and /or equipment which will be used an the farm directly in harvesting farm crops grown and used on the farm as teed for poultry or livestock by a producer falling under the cal.gories 2, 3, or 4 above. O.C.G.A. 48- 8- 3(29)(E) j Machinery and /or equipment which will be used in the hatching and breeding of poultry and livestock for sale. O.C.G.A. 46 -8- 3(29)(8) Machinery and /or equipment which will be used in tilling the soil or in anirn i husbandry. O.C.G.A. 48- 8- 3(29)(F) -(G) (H) J a. Machinery and /or equipment which will be used exclusively for irrigation of farm crops grown for sale including, but not limited to fruit, vegetable and nut crops. O.C.G.A- 48 -8 -3(26) I J 9. Pecun sprayers, pecan shakers and /or other equipment used in harvesting pecans. O- C.G.A- 48- 8- 3(29)(J) i '0 Equipment which will be used on the farm exclusively In processing onions. O.C.G.A. 48 -8- 3(29)(1) TIMBER EQUIPMENT AND RELATED ATTACHMENTS 11 Ofi-road equipment and related attachments which will be used exclusively in the site preparation, planting, cultivation, or harvesting of limber. This shall include all off -road equipment and relatod attachments used in every forestry procedure starling with the severing of a tree from the ground until and including the point at which the tree or its parts in any form has been loaded in the field in or on a truck or other vehicle for transport to the place of use. O.C.G.A- 48-8-3(29).l) LIVESTOCK, SEED, FERTILIZER, FEED, PACKAGING, ETC 12. Cattle. hogs, sheep, horses, poultry, and bees when said for breeding purposes. O.C.G.A. 48 -8 -3(28) J 13. Soed, seedlings, fertilizers, insecticides, fungicides, rodenticides, herbicides. defoliants, soil fumigants, plant growth regulating chemicals. desiccants (including shavings and sawdust front wood, peanut hulls, fuller's earth, straw and hay) and feed for livestock, fish or poultry when used either directly in tilling the soil or in animal, fist', or poultry husbandry: and /or, nonreturnable materials used for packing farm products for shipment or sale. O.C.G.A. 48 -8 -3(25) (35) (A) (iii) -FUELS USED IN POULTRY STRUCTURES ELECTRICITY USED IN IRRIGATION OF FARM CROPS- 14. The sale of electricity for rho operation of an irrigation system which is.used on a farm exclusively for irrigation of Tarr,, crops when separately metered. O_C, G. A, 48 -8 -3(64) Jt 15. Liquefied petroleum gas or other fuel used in a structure in which broilers, pullets. or other poultry are raised when separately metered. O C.G.A 48 3(49) ILLINOIS: The reverse signed hereby certifies that ilia property purchased will be used primarily in production agriculture or in State or Federal agriculture programs. Any farm chericals purchased as exempt are such pursuant to Section 130.1955. KEN'T'UCKY: The reverse signed hereby certifies that they are a farmer regularly engaged in the Occupation of: (farmer must initial appropriate line(s)) tilling and cultivating ilia soil for the production of crops: raising and feeding livestock or poultry the products of which ordinarily constitute food for hurnan consumption; or raising and feeding Ilarnas „alpacas, ratites, buffalo, or aquatic organisms. The reverse signed also certifies that the Tangible personal property purchased as indicated below will be used for the exempt purpose(s) provided for under KRS 139.480. Farmer must /NIT /AL appropriate line(s). Baling twine and wire saY3s ;as :Y :Yf IIY1YYY:II Farm chemicals yy�/ yy♦tr• 1. V Farm machinery, attachments and repair /replacement parts therefor OFT �1�Urt{:� NF I.l•22N1!A 1_ocgr! >.,t,- CJ �•UJ Farm work stock (1jP19L g6C1 f2 (�li} �9LQ+ �•iiG�. }it•LI and feed additives 8S2 ()0 Gasoline, special fuels, r aturaf gas or liquefied petroleum gas Livestock or poultry the products of which ordinarily constitute food for human consumption P)QI) �JJTA gL14fq r 08 E UI R.wites, (lamas, alpacas, buffalo, or aquatic organisms Machinery, equipment, attachments and repair /replacement parts therefor to be incorporated into an existing on IarnEQBj&r,1446 faflifOIGAd `(Stl�r(trf)&v�t�kt n +ria't�te� fr rife. alpaca, or aq Iture facilities' f+ 911 i oo 4o D�j Seed or fertilizer 1,V \t! -01�1 <1 M uJV 14yAa }Q Materials to be incorporated into the renovation or repair of an existing on -farm grain /soybean facilities and poultry, Ii��:�, �Ip;gct� orsia�ft): �Iy��r r�lgi�tY.Y g Y y Water used in the production of crops as a business or in the raising of livestock /poultry, ratites, llamas. alpacas, buff IIt 44 yyqua c erg, m ms yes des Clairy caTTtIS. SET_ REVERSE SIDE SEE RE_ VERSEMIDF_ Yy9 Y Y YY YYYYY YYYYYYYE :YIYYYIYFYYY= Signature Date MICHIGAN: The reverse signed hereby certifies that all items. except as indicated, are purchased for use or consumption in connection with the production of horticultural or agricultural products as a business enterprise. and agrees to reimburse the seller the sales tax if used or consured otherwise. Unlawful use of this certificate subjects pars... to the penalti.s of the sales TO act. NORTH DAKOTA, SOUTH DAKOTA: The purchases made herein are subject to the reduced rate of sales tax and are not exempt from such tan.-_.-,._ NEBRASKA: The reverse signed certifies the intended use of the items purchased renders it exempt under Reg. 1 -060, 1 -061 or 1 -063. TEXAS CERTIFICATION OF EXEMPTION 2TZ09 }(ILG: Purchaser's name SFF REVERSE SIDE, Street Address SEE REVERSE SIDE City, state, zip code SEE REVERSE SIDE I claim an exemption from payment of sales and use taxes for the purchase of taxable items described below or on the attaohed order or invoice: SEE r REVERSE tp bo SIDE scri JJCCQ1Q9JJC6 (n1 LL.f F}!6 f OLQPQ'!.JL,_ yea( Deption of items (or an attached ortlor o Invoice) purchased: SET= REVERSE SIDE x' 16 LickCL IPFIJ UI l, LL Lfti la, -16 �)JlI rl:; 1 't I claim this exemption for the following reason: SEE REVERSE SIDE I understand that I will be liable for payment of sales tax which may become due for failure to comply with the provisions 010!jyA. TZS�C�Ctt4:i0.irlykeJ1",Iys F1<cisi9J r Municipal Sales and USe Tax Act, Sales and Use Taxes for Special Purpose Taxing Authorities. County Sales and U 1 Tax Act, Cou ty Adalth Services Sales and Use i ax and the foxes Health and Safety Cod o: Special Provisions Relating to Hospital Districts, Emergency Services Districts. and EmE;XJ ptcy Services District. in counties with a population of 125, 000 or less. Liability for the tax will be determined by the price paid for the taxable Items purchased or the fair market rental values �La per' t dd' 1, Ei LurC�) 6 A ll'1 J I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items which I know, at the t d4 II vela lJS edrFi a manrier oTh er that expressed in this certificate. Seller: SEE REVERSE SIDE Street address: SEE REVERSE SIDC- City, state, zip code: SEE REV _RS S DE Purch eser's signature: SEE REVERSE_ SIDE Data: P rill $EE REVERSE SIDE 6�.0 ll� t. /lf N This certificate does riot require a number to be valid. Safes and use tax exemption numbers or tax exempt nurnbers do not exist. do WO ON 12M pr li V a 11 IS t ?v'CI certificate should be furnished to the supplier: Do not send the completed certificate to the Comptroller of Public Account$, F ffecirve Date: Septamber 1 0, 1991 or C: O: Y Y Y Y Y +Y Y Y U L ?ii Rule 3.28 J NEW YORK STATE DEPARTMENT OF TAXATION AND FINANCE NEW YORK STATE AND Lo S{,��F, ,s AND USE TAX 2 FARMER'S EXEMPTION CERTIFICATE to purchasers and sellers: a be completed by the farmer, given to and retained by the seller. To have a valid certificate. all am jrEep"ust be completed. :26, QB Read all Instructions carefully before completing or accepting this certificate. J. To salters: You may not accept this certificate as the basis for selling exempt from tax the property or services listed below. TaAr4Q el& Aected on such Salo$. (;t This carte /icara may not be used to claim exemption tar the following: .�t j uu77 1 utilities, fuel oil, ,,.[a,* r fuel or diesel fuel: 2. labo charges in y �E[1t connection with repair. maintenance of or service to real propertiale personal property incorporated into b3tiding, structure, sib foundation or other capital improvements to real property (excluding grape trellises and the remaining portions of a silo): 4. motor vehicles; or 5. property listed as taxable. Name of seller TRACTOR SUP COM AFFILIATES Attn: T ax Name of Farmer SEE REVE SIDE Street address 200 Powell Place Street address EE REVERSE SIDE i1r 1jcZ6Jl r TK-' City Brentwood State TN ZIP Code 37027 City_ SEE_ RE SIDE Slate zIP C Code Check applicable box: (ZI Single Purchase Certificate Q Blanket Certificate 1 U0 La Cl�j G� l•l: 1 1 the reverse signed hereby certify that I am exempt from payment of the sales and use tax on tangible personal property p to be used for Una �pc 'LY�}� an exempt purpose and that certain services are also exempt when performed on an exempt property. (Check applicable box lst.� W V� C1C1 CIIC•U .`i (a) TO 791ble personal property, except property incorporated into a building or structure, for use or consumption directly and predominately in the production of tangible personal property for sale by farming, including stock, dairy, poultry, fruit, fur bearing animal, and truck farming. The term farming also Includes ranching, operating nurseries, greenhouses or other similar structures used primarily for the raising of agricultural• horticultural o0 .?21t�t�.=Jfll�ectaltnOC iAys, and operating orchards or vin r eyads. rp C JA p l� J (b) Tangible personal property for use in erecting, adding to, altering or Improving a silo used in farming to ma 'C'.] s �4��"t1V pl1 tSn fi JIq .Np; cv such tangible personal property is to become an integral component part of such silo. (This exemption does not apply to tangible persona property used in constructing a silo foundaitIO (c) Posts and wire for use in constructing or maintaining vineyard trellises used in growing grapes for sale. 1 c�r, i (d) Sery fees of Installing, repairing, maintaining and servicing exempt tangible personal property. (This exemption ,3 "I or+ kith state and local sales and use tax with the exception of the tax Imposed by or for New York City 1 he, ;a stalcrnents are mad. with the knowledge that willfully issuing a false or fraudulent certificate with the intent to evade'Ta�C'fS �Rlfs23. n5b and s�ction 1817(m) of the New York State T.- I_aw and section 210.45 of the penal law punishable by a fine of not more than $1,000, or imprisonment for not(1 tFrnla{�,y ot}loth. 1 s of farmer or farmer's a SEE REVERSE SIDE „gna m r pre$ontative (state titles and relationship) Seller The tax exemption for farmers is limited to the purchases of (1) tangible personal property used directly and predominantly in the production phase of farming and (2) the services described in (d) related to that properly- Purchases for use in administration, storage or marketing or purchases at Tangible personal property used p �dlregtly�a Qlu rl,�r �VVOUItl not qualify. (See Publication 844, Sales Tax Information /a, Farriers, for a complete explanation of the tax treatment of farmers purchases a rid sales.) i (_an rT G` t ir4q C F.r .,,r y protection, a (armor r lust give you this certificate not later than 90 days after delivery of the property sold or services rendered. If you h <�vo not ecG i,$ Qerli(ica[e within 90 days of the date of sale, five sale will be deemed to have been taxable at the time dto transaction took place and the burden of proving it was n�t,� ll �1 (irJ.fvrrf; ;Wf6,�I^^[ J_drtl ;e purchaser. If the blanket certificate box is checked, you may consider' this certificate part of any order received from the purchaser. A blanket certificatl42M in TB VuLt purchaser gives you written notice of revocation, or until the Tax Department notifies: you that the purchaser may not make exempt purchases. Purchaser You must pay tax on utilities (telephone, telegraph, electricity or gas service) heating oil, motor fuel and diesel motor fuel at the time of purchase and clairn a refund for any exempt use. (if you are purchasing diesel motor fuel for exclusive consumption in farm machinery used to produce tangible personal property for sale, you may use Form FT -1004, wavers Exemption Certificate for Purchases of (Diesel Motor Fueor to purchase that fuel exempt.) It 11r•- blanket certificatte box is checked, you may-consider this certificate part of any order received from the purchaser. A blanket certificate remains in force until the purchaser gives you wafter', notice of revocation. or until the Tax Department notifies you that the purchaser may not make exempt purchases. r_ -r te- 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)) 08/26/09 $284.97 1 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 N WAR NO. Tractor Supply ALLOWED 20 IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $284.97 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 2201 2201-670.99 $284.97 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Thurs6ay, LustLL27, 2009 Street Commis i er le Title Cost distribution ledger classification if claim paid motor vehicle highway fund