The URL can be used to link to this page

172585 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 t, ONE CIVIC SQUARE TRACTOR SUPPLY CO 4 CARMEL, INDIANA 46032 PO BOX 689020 CHECK AMOUNT: $573.74 DES MOINES IA 50368 -9020 CHECK NUMBER: 172585 CHECK DATE: 5/1312009 DEPAR ACCO PO NUMBER INVOICE NUMBER AM OUNT DESCRIPTION 2201 4237000 STREET 481.93 6035301200050860 2201 4238900 STREET 91.81 6035301200050860 page 1 of 17 TX 7 D 13000 ®SU Yi C BUSINESS ACCOUNT 0000376 �K AGCQ UNT SUM�A�ARY k G0� 35 =3012 0005 0860 2. f� �"!3 Previous Balance, 1,335.85 Closing Date 04/20/09 Payments 1,403.45 Next Closing Date 05/19/09 CARMEL STREET DEPT Credits 104.00 Payment Due Date 05/15/09 CINDY Purchases 677.74 3400 W 131 ST ST Debits 0.00 Current Due 506.14 WESTFIELD, IN 46074 -8267 FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 506.14 Credit Available 4,743 New Balance 506.14 CURRENT ACTIVITY Transaction� 1 0 Location/ �g r� Amou�rtt Description� �k�Is �st y i of MAR 23 GOODS AND SERVICES WESTFIELD IN 269.74 APR 10 GOODS AND SERVICES WESTFIELD IN 44.98 APR 15 GOODS AND SERVICES WESTFIELD IN CREDIT 49.99 TOTAL 6035301200074803 $264.73 APR 1 GOODS AND SERVICES WESTFIELD IN 44.99 APR 9 GOODS AND SERVICES WESTFIELD ;IN 32.51 APR 14 GOODS AND SERVICES WESTFIELD -IN 49.99 TOTAL 6035301202895916 5127.49 MAR 19 GOODS AND SERVICES WESTFIELD IN 82.96 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Da ly Days in ANNUAL Subject [o Periodic B lung PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Charge Rate Per RATE Finance Charge Rate Penod RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 32 0.00 0.00 .00000 29 0.00 This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1- 800 -559- 8232_ FAX NUMBER 1- 801 -7425 Information About Your Account, purchases and an average daily balance method (including new transactions) Grace Period on Purchases. You can avoid periodic finance charges on for cash advances, If your account is subject to a daily periodic rate we figure purchases, but not on cash advances. This is called a grace period on the periodic finance charge by multiplying the daily balance by its daily purchases. You can get a grace period of at least 20 days. To do so, pay the periodic rate. We do this for each day in the billing period. In addition, for each following amounts by the due date every billing period: the New Balance purchase balance, we multiply the daily balance for each day of the previous (subject to the Promotional Balance Exceptions), plus the minimum monthly billing period by its daily periodic rate. If your account is suhiect to a daily payments required for your No Interest and 0% balances. If you do not, you periodic rate we figure the periodic finance charge by multiplying each will not get a grace period unless you pay those amounts by the due date for Balance Subject to Finance Charge by its monthly periodic rate. In addition, we two billing periods in a row. The two Promotional Balance Exceptions are: (1) multiply the Balance Subject to Finance Charge for each purchase balance for You do not have to pay any No Interest or 0% balances that do not expire by the previous billing period by its monthly periodic rate. Whether your account the Next Closing Date shown on the billing statement. (2) You can pay any No is subject to a daily or a monthly rate, for each balance, we add up all the daily Interest or 0% balances that do expire by the Next Closing Date shown on the balances for the billing period and divide by the number of days in the billiFig statement by the later of the promotion's expiration date or the statement's period. This gives us the Balance Subject to Finance Charge for that balance payment due date. for that billing period. We do not calculate periodic finance charges for the r promotional n promotional offers may take away the grace period on purchases. previous billing period if your account was credited for the full New Balance, Certain may allow to have a period Plus the minimum monthly payments required for your No Interest and 0 11 /q P Y you grace an chase P balances, on your previous billing statement by that statement's payment oue without having to pay all or a portion of the promotional balance by the due date (subject to the Promotional Balance Exceptions described above in the date. If either is the case, the promotional offer will describe what happens. Grace Period on Purchases) or a periodic finance charge was already billed on that balance, If your account is subject to a daily periodic rate, for each cash Balance Subject to Finance Charge. We calculate periodic finance charges advance balance, multiply the Balance Subject to Finance Charge by the separately for each balance. Balances include regular purchases, regular cash number of days in the billing period and f the applicable daily periodic rate. The result is the periodic finance charges for that balance. For each purchase advances, and different promotional balances. balance, multiply the Balance Subject to Finance Charge for the current billing To get a daily balance, we start with the balance as of the end of the period by its daily periodic rate and by the number of days in the billing previous day. We add any new charges. We then subtract any new credits or period. Then do the same thine for the Balance Subject to Finance Charge for payments and make other adjustments. A credit balance is treated as a the previous billing period (if there is one) using the daily periodic rate and balance of zero. If the rate on a balance is a daily rate we include in the daily number of days in that billing period. Add the two results and you will have balance any periodic finance charge on the previous day's balance. (This the total periodic finance charge for that balance. Rounding may cause a small results in daily compounding of finance charges.) difference. If the rate on a balance is a daily rate we use an average daily balance method (including new transactions). We figure the periodic finance charge by Notify Us in Case of Errors or Questions About Your Bill. If you think your multiplying the daily balance by its daily periodic rate. We do this for each day bill is wrong, or if you need more information about a transaction on your bill, in the no period. The Baiance Subject to Finance Charge is the average of write us (on a separate sheet) at the Billing Errors address on this statement the daily balances during the billing period. If you multiply this figure for each as soon as possible. We must hear from you in writing no later than 60 days balance by its daiiy periodic rate and by the number of days in the billing after we send you the first bill on which the error or problem appeared. In period, the result is the total periodic finance charge on that balance. your letter, give us the following information: Rounding may cause a small difference. o Your name and account number. Alternate Balance Subject to Finance Char Calculation Method. If the o The dollar amount of the suspected error. front of your statement has a message stating this account is subject to the o Describe the error and explain, if you can, why you believe there is an Alternate Balance Subject to Finance Charge Calculation Method we use a error. If you need more information, describe the item you are unsure two -cycle average daily balance method (including new transactions) for about. Important Payment Instructions. Copy Fee, We charge $5 for each copy of a billing statement that dates back 3 Crediting Payments. We must receive your payment in proper form at our months or more. We add the tee to the regular revolve credit plan balance. We processing facility by 5 p.m. local time there. If we do, it will be credited as of waive the fee if your request for the copy relates to a billing error or disputed that day. A payment received at the processing facility in proper form after purchase. that time will be credited as of the next day. Allow 5 to 7 days for payments by Payment Options Other Than Regular Mail. regular mail to reach us. There may be a delay of up to 5 days in crediting a o Pay by Phone Service. You may use this service any time to make a payment we receive that is not in proper form or is not sent to the correct payment by phone. You will be charged $14.95 to use this service. Call by 5 address. The correct address for a payment sent by regular mall is the address p,m. Eastern time to have your payment credited as of that day. If you call listed on the return envelope or on the front of the payment coupon. A after that time, your payment will be credited as of the next day. We may payment made in-store is not sent to the correct address. The correct address process your payment electronically after we verify your identity. for a payment sent by courier or express mail is the Express Payments Address shown below. o Express Payments. You can send payment by courier or express mail to payment sent b mail or courier to be in proper form, you the Express Payments Address: Customer Service Center, Dept. GCS 911, Proper Form. For a pa Y Y P 4740121st Street, Urbandale, IA 50323. Payment must be received in proper must: form at the proper address by 5 p.m. Central time to be credited as of that Enclose a valid check or money order. No cash, gift cards, or foreign day. All payments received in proper form at the proper address after that currency please. time will be credited as of the next day. Include your name and account number on the front of your check or Report a Lost or Stolen Card Immediately. Yo,i may call Customer Service money order. 24 hours a day, 7 days a week. If you send an eligible check with this payment coupon, you authorize us to complete your payment by electronic debit. If we do, the checking account will be debited in the amount on the check. We may do this as Tractor Supply CRC S603TV Rev. 07108 soon as the day we receive the check. Also, the check will be destroyed. 603TV5740708-Cit page 2 of 7 Tx 7 D 130000000 TRACTOR° ®sumyCo- BUSINESS ACCOUNT 0000377 CURRENT ACTIVITY datid Transaction; Amount .�Al m 'faascnP ion APR 10 GOODS AND SERVICES WESTFIELD IN 15.58 APR 10 GOODS AND SERVICES WESTFIELD IN CREDIT 9.02- TOTAL 6035301202895965 $89.52 APR 15 GOODS AND SERVICES WESTFIELD IN 40.98 TOTAL 6035301202896013 $40.98 MAR 30 GOODS AND SERVICES WESTFIELD IN 5.85 MAR 30 GOODS AND SERVICES WESTFIELD IN 16.32 APR 8 GOODS AND SERVICES WESTFIELD IN 29.24 APR 8 GOODS AND SERVICES WESTFIELD IN 35.82 APR 15 GOODS AND SERVICES WESTFIELD IN 8.78 TOTAL 6035301202896120 $96.01 APR 2 GOODS AND SERVICES WESTFIELD IN CREDIT 44.99 TOTAL 6035301202896161 $44.99 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS MAR 19 PAYMENT REF P9194002FO9PLZEHD 531.89 APR 10 PAYMENT REF P9194003409PGGBJG 871.56 This account is subject to the Alternate.Balance Subject to Finance Charge Calculation Method. See back for details. t Remit To: Bill To: Page 3 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 T 0R DEPT.30 1200050860 JEFF STEWART wr SUMYCO2 PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000378 Payment Due Date: 05/15/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 624001100111010 431000916868010 Purchase Order: Purchase Order: SHOP 32309 AMOUNT DUE: 15.99 AMOUNT DUE: 269.74 Store: 574000624 INVOICE DATE: 03/10 /09 Store: 574000431 INVOICE DATE: 03/23 /09 TANK CLEANER OT 4201797 1.00 15.99 15.99 HOSE SUCTION 11/2K20 CO 2107939 1.00 28.99 28.99 PUMP PACER SERIES 525 2 2135958 1.00 240.75 240.75 SUBTOTAL 15.99 TAX 0.00 SUBTOTAL 269.74 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 15.99 TOTAL 269.74 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000921430010 431000922539010 Purchase Order: SHOP AMOUNT DUE: 44.98 AMOUNT DUE: 49.99 Store: 574000431 INVOICE DATE: 04/10 /09 Store: 574000431 INVOICE DATE: 04/15 /09 PAINT TBI SPR JD GN 3449449 1.00 4.99 4.99 BOTTLE JACK 20T SHORTY 0116623 1.00 49.99 49.99 PUMP PULL UP BARREL 3957816 1.00 39.99 39.99 SUBTOTAL 49.99 SUBTOTAL 44.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 49.99 TOTAL 44.98 V Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 Remit To: Bill To: page 6 or 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860�R DEPT.30 1200050860 MIKE HENRICKS VSUMYCO- PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000381 Payment Due Date: 05/15/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP To: INVOICE: 431000918708010 431000918597010 Purchase Order: Purchase Order: 33009 33009 AMOUNT DUE: 5.85 AMOUNT DUE: 16.32 Store: 574000431 INVOICE DATE: 03/30/09 Store: 574000431 INVOICE DATE: 03/30 /09 POLY ELL 90DEG INSERT 1 3150244 1.00 0.99 0.99 LOCKPIN SW 1/4 X 2 1/2 1633553 1.00 2.29 2.29 POLY ELL 90DEG INSERT 1 3150244 1.00 0.99 0.99 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29 TUBING BRAIDED PVC 1/2 3129227 3.00 1.29 3.87 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29 SUBTOTAL 5.85 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29 TAX 0.00 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29 SHIPPING 0.00 HEX PLUG W MALE TPT 1/2 2110550 1.00 1.29 1.29 HEX PLUG W MALE TPT 1/2 2110550 1.00 1.29 1.29 TOTAL 5.85 SUBTOTAL 16.32 TAX 0.00 SHIPPING 0.00 TOTAL 16.32 SHIP TO: INVOICE: SHIP To: INVOICE: 431000920902010 431000920810010 Purchase Order: Purchase Order: 40809 40809 AMOUNT DUE: 35.82 AMOUNT DUE: 29.24 Store: 574000431 INVOICE DATE: 04/08 /09 Store: 574000431 INVOICE DATE: 04/08 /09 CUTOFF WHEEL 4 1/2X.045 3805344 6.00 1.99 11.94 CLAMPS 30A INS 1041685 1.00 2.99 2.99 MTL WHEEL 4X .045 X 5/8 3910157 12.00 1.99 23.88 FLAT SEAT HOSE BARB 3/ 2114376 1.00 1.29 1.29 LENS 4 1 /4X5 CLEAR PLAS 3896727 1.00 4.49 4.49 SUBTOTAL 35.82 LENS 4 1 /4X5 CLEAR PLAS 3896727 1.00 4.49 4.49 TAX 0.00 LENS GO SHADE 10 4 1 /2X 3948257 1.00 6.49 6.49 SHIPPING 0.00 BRUSH 6IN FINE WIREWHL 3822150 1.00 7.49 7.49 TOTAL 35.82 SUBTOTAL 29.24 TAX 0.00 SHIPPING 0.00 TOTAL 29.24 f l i Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 Zia Remit To: Bill To: Page 4 or 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30 1200050860 RANDY JOHNSON wsumyco- PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000379 Payment Due Date: 05/1.5/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP ro: INVOICE: 431000919174010 431000921035010 Purchase Order: Purchase Order: TRUCK14 TRUCK14 AMOUNT DUE: 44.99 AMOUNT DUE: 32.51 Store: 574000431 INVOICE DATE: 04/01 /09 Store: 574000431 INVOICE DATE: 04/09 /09 HOSE FUEL TANK 1X14 3958286 1.00 44.99 44.99 BRUSH 6IN FINE WIREWHL 3822150 1.00 7.49 7.49 SPECIAL ORDER ARTICLE 0222220 1.00 40.00 40.00 SUBTOTAL 44.99 TAX 0.00 SUBTOTAL 47.49 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 44.99 TOTAL 32.51 V SHIP TO: INVOICE: SHIP TO: INVOICE: 431000922301010 431000915743010 Purchase Order: Purchase Order: SHOP GROUNDS AMOUNT DUE: 49.99 AMOUNT DUE: 82.96 Store: 574000431 INVOICE DATE: 04/14 /09 Store: 574000431 INVOICE DATE: 03/19 /09 BOTTLE JACK 20T SHORTY 0116623 1.00 49.99 49.99 1 TON CHAIN HOIST 0116657 1.00 73.98 73.98 CABLE 12IN 4G RD SWITCH 0474403 1.00 4.49 4.49 SUBTOTAL 49.99 CABLE 121N 4G RD SWITCH 0474403 1.00 4.49 4.49 TAX 0.00 SHIPPING 0.U0 SUBTOTAL 82.96 TAX 0.00 TOTAL 49.99 SHIPPING 0.00 TOTAL 82.96 V Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 Remit To: Bill To: Page 5 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 R DEPT.30- 1200050860 RALPH BURKE ®Su "LYL''O PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000380 ME Payment Due Date: 05/15/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP T O: INVOICE: SHIP TO: INVOICE: 431000921328010 431000921325010 Purchase Order: JA AMOUNT DUE: 15.58 AMOUNT DUE: 9.02 Store: 574000431 INVOICE DATE: 04/10 /09 Store: 57400043/ INVOICE DATE: 04/10 /09 CLEVIS 1/21N SCREW PIN 0268030 1.00 7.79 7.79 1 TON CHAIN HOIST 0116657 1.00 73.98 73.98 CLEVIS 1 /2IN SCREW PIN 0268030 1.00 7.79 7.79 STRAP 1INX15FT 750LB LO 3040041 1.00 14.99 14.99 STRAP IINK15FT 750LB LO 3040041 1.00 14.99 14.99 SUBTOTAL 15.58 BUCKET MUCK HGN 2229278 1.00 17.49 17.49 TAX 0.00 BUCKET MUCK HGN 2229278 1.00 17.49 17.49 SHIPPING 0.00 SUBTOTAL 138.94 TOTAL 15.58 TAX 0.00 SHIPPING 0.00 TOTAL 9.02 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000922543010 431000913957010 Purchase Order: Purchase Order: 41509 3112009 AMOUNT DUE: 40.98 AMOUNT DUE: 57.93 Store: 574000431 INVOICE DATE: 04/15 /09 Store: 574000431 INVOICE DATE: 03/12 /09 DYNAMARK SPRAY DYE 4201373 1.00 24.99 24.99 WHEEL 7X1 /4X5 /8 11 META 3818363 1.00 8.99 8.99 TANK CLEANER QT 4201797 1.00 15.99 15.99 WHEEL 7X1 /4X5/8 11 META 3818363 1.00 8.99 8.99 WHEEL 7X1 /4X5 /8 11 META 3818363 1.00 8.99 8.99 SUBTOTAL 40.98 SAW WHEEL 14%3/32X7/64% 3805653 1.00 6.99 6.99 TAX 0.00 SAW WHEEL 3805653 1.00 6.99 6.99 SHIPPING 0.00 SAW WHEEL 14X3/32X7/64X 3805653 1.00 6.99 6.99 MTL DEPRESSED CTR ABRAS 3811175 1.00 9.99 9.99 TOTAL 40.98 SUBTOTAL 57.93 TAX 0.00 SHIPPING 0.00 TOTAL 57.93 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 I Remit To: Bill To: page 7 or 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 �R DEPT.30 1200050860 MIKE HENRICKS ®SUpptiyCO PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000382 Payment Due Date: 05/15/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000922528010 431000913486010 Purchase Order: Purchase Order: 41509 3102009 AMOUNT DUE: 8.78 AMOUNT DUE: 43.91 Store; 574000431 INVOICE DATE: 04/15 /09 store: 574000431 INVOICE DATE: 03110 /09 NIPPLE 1 /4X2IN GALV 5149780 1.00 1.49 1.49 TANK CLEANER QT 4201797 1.00 15.99 15.99 THROTTLE CONTROL UNIV C 4441004 1.00 7.29 7.29 HITCH PIN I /2X4IN 3PT 0268666 8.00 3.49 27.92 SUBTOTAL 8.78 SUBTOTAL 43.91 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 8.78 TOTAL 43.91 SHIP TO: INVOICE: 431000919353010 AMOUNT DUE: 44.99 Store: 574000431 INVOICE DATE: 04102 /09 HOSE FUEL TANK IX14 3958286 1.00 44.99 44.99 SUBTOTAL 44.99 TAX 0.00 SHIPPING 0.00- TOTAL 44.99 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425 REMIT TSC BUSINESS ACCOUNT l Toi® PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLYC0 y P.O. Box 9020 trrc ir�r Sura iY Cam,,, Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number iJe 3 t f ie1.d. I17 f'..60 t" 6035 301 i �17) 667 0 NAME L> ?:j 51 t< I DE �tl l� ut t, Ji J ADDRESS 61 -ST1 f" Lf) 1 4'07. CITY STATE ZIP PHONE rrS 1 7060 0 1 Z a? 3J: CUSTOMER TO. COMPLETE 01 16623 Su{ tt JAi:K 7011 '::HOR I.00 Lf 1Q.7" 4?, 91? M CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: C>ovorw? :erlt A cn ie The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal uWOto 47 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00:•. 1 Diu 0.00 indicated below and understands Total 4;',Y;� and agrees with the General engaged in the business of agricultural production of TSC C,�r d 5�9.9H food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or ki- ct "'t2<9s21AZaZ34PJ9; the applicable statement of the other agricultural production items purchased free of PQthY' Ref respective state printed on the tax, as defined by state law, and as indicated below. Ckiw3 0 0 reverse side of this form. Cash 1.tiLk PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they understand the may be liable for p ayment of all taxes Ruyer UcLituwlei;yr.:_, iiie rQceiPi u �i r Ie STATE: y y p y 4. (REQUIRED) due on the purchase price for the goods as allowed by`� (Exceptions: Georgia, New York Kentucky state law should suc goods be used or consumed ip COPY 01 tllL 3 51 1P dnd the PUrcli iEt: o COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. ti.te deDCr Ued PURCHASER IS ENGAGED IN: (REQUIRED) �i.C11t'i1rirtC.t Wi.1'h ttl'2 tclTdtlll�'!' Ali "£E'I':ctit F7 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: $:lty?'�.''>.. ',sSt (!i: }441iy ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Z'3 2 g 2 V'3 Farm Machinery/Repair Parts Government Agency (Entity Col 800 w i I i i i n 7 days t o Livestock Injestibles or Injectibles Exempt Organization (Entity :actP le e a ,wt v,v .,'lid fez Gu i ure J t,t a PertiIizer /Ag riche micals INC: only DOT and US Government are exempt ;,mI- drawir,3 for a Ch�ince to t..in a Resale {Sales Tax Permit 2', 00 :,i;U�' e 1 `_t 51' I c 1 Consumed in Production (KS) (Awar led a bi f t Card) f10 i' UISLN "3L Ingredient or Component Parts (KS) UN EURVLY VELE5S(NO Eao' 9/30/05' 8$ 31S86SakZT ,S ;u3$3$F,SSb4'f'Sa'SSa$t$ Other: Ett Store 01S1 C NATURE; (REQUIRED) MGR. AP USE t. GASH CHECK VISA M/C .DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORI REMIT TSC BUSINESS ACCOUNT PAY M NTS TO: R® TRACTORS PPLY COMPANY v s u% ry CO P.O. Box 9020 Des Moines, IA 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit-Account Number '1.1i j T 1 (6035301 NAME is i r-i r.-"T ADDRESS CITY STATE ZIP PHONE •131 U i '2009 09: 5 -i w. CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Covet The undersigned certifies The undersigned party certifies their exemption from r compliance with the agricultural payment of sales and use tax on tangible personal IUtaial l'.9" sales tax exemption law of the state property as indicated below and /or purchaser is i 0, O0 indicated below and understands Tui't i:,i5" and agrees with the General engaged in the business of agricultural production of I C d i 91; Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for r r� �g 8� "1 the applicable statement of the resale and/or uses the farm machinery, equipment or Auths:01 ,OSZ Ref:' 140054225 respective state printed on the other agricultural production items purchased free of r. 0;s1 ol reverse side of this form. tax, as defined by state law, and as indicated below. Eafi_;r 0 O The undersigned art further certifies the CayF B °rk PRODUCT IS TO BE USED IN THE FOLLOWING understand the may be liable for p ayment of all taxes STATE: y y p y i ti': C1' Ll;ll?il1�L�E5 thl rereiP' o; a '77 (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Geor New Y ork a Kentucky state law should such goods be used or consumed in' COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. t�` "f :wa .1 i a the o f PURCHASER IS ENGAGED IN: (REQUIRED) th:: ur�rf /bed i,' •i GltlHdl. 5h_11 in Resale Under penalty of perjury, signee swears the ;ti ,.Uaat_ its tl Coitct{it „d�, 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 "J uI Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity# 8E': e "88T:9: °„8sb.S3:3<' X45 ^FF:'3^i?E Livestock Injestibles or Injectibles Exempt Organization (Entity 11 :IL'L' S.'i� 073 4 o i rt, I1 Ci; iG INC: only DOT and US Government are exempt i.o "I'l.ete a !Atrv as I b_ entered i1i ,t Fertilizer /Agrichemicals htonfit' ui a;JT.t73 �o; r-3 ;yi❑ Consumed in Production (KS) Resale (Sales Tax Permit n2500 C,; i 7 W i it eP r r'c (Aw,aeded a,- Gtfi i'a:rd) J f'!J(EHASt_ Ingredient or Component Parts (KS) OR 12;ZVEY Ni'LlISSARY Ell& �t3J /0'i Other: 8,•43888334✓,i SB'2:t:;33:8�t #8. zS ?:t83CL'P CUS E SIGNATURE: (REQUIRED) MGR. APPROVAL USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE: U DESCRIPTION UNIT PRICE Farm No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT �RO. PAYMENTS TO: TRACTOR SUPPLY COMPANY off aw"LYC� P.O. Box 9020 Tl'd� i „r Surl 1; ,al„ any Des Moines, IA 50368 -9020 1 c 1 uo Ll 31 'iu i -i h TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number uc. iMC -1u, ti! 6035 301 (317) 867 -3505 NAME LAkHLE L STRlE L1 i!i-F' 1 3400 I<t 131 S'F ST ADDRESS 41E5"FF(ELD IN !60748267 (3i 7) S's 2001 CITY STATE ZIP PHONE 431 786000104 2 916868 'J3/2;; 02:08FG CUSTOMER TO COMPLETE 21C,'. ,9 HU5- GU;alo;, 11 X1:''0 i. U 2P 7i 201 1r CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gor;crnme nt A�cncie� The undersigned certifies The undersigned party certifies their exemption from 21i S591, FU iP PACER SERf1.:5 52 compliance with the agricultural payment of sales and use tax on tangible personal i 00 r 240.75 240. 7.5 NT sales tax exemption law of the state property as indicated below and /or purchaser is Covhraman l� :ncies indicated below and understands engaged in the business of agricultural production of and agrees with the General S�63to(nl 269,74 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00% T�.: 0.00 the applicable statement of the Total 269, 7 respective state printed on the other agricultural production items purchased free of I'SC Czrd 269.74 reverse side of this form. tax, as defined by state law, and as indicated below. rlcc t 8 3 E 3 1803 PRODUCT IS TO BE USED IN THE FOLLOWING The under p arty y further certifies the Autht:023206 Ref ^:2313080460 Q 0 STATE: understand they may be liable for payment of all taxes l 1 0 alr� 0 0 ,00 (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) Buyer AC 4,two 'i 38� iihE t o v i'!!:1Plc Resale Under penalty of perjury, signee swears the F Government information on this statement is true and correct in �i1PY of ini� 5alrs sl.ir> and the Exempt organization every material manner. A willfully false representation +h< u"c, ivied n1�r Litat�di e ,ltal!. i„ F Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other provisions as allowed under state accardance ui il: the Cardholtlat Livestock Production Floriculture /Aquaculture Production law' Other: 'i�natt!.ra: ITEMS PURCHASED WILL,BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity NC: onlyDOT and US Government are exempt tYYY8tS8ttStII82ttE tYtttt3EtYttEltEtt8t Fertilizer /Agrichemicals ;3 4.:ad:.:Y288YY$434 339'.StS$34 14.' Z'> Consumed in Production (KS) Resale (Sales Tax Permit Call $00 -0734 within 7 days to Ingredient or Component Parts (KS) coiilPleiu a Survey and be entered in a monthly dr•atwins fur a chance to oin o Other: $2500 1jhoa'rins spree. (Awarded as Gift Card) NO F'IJN;Cl -l.SC CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL 2 IN USE SHADED AREA ONLY WHEN REGISTER IS CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE I ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY W BI UN% y co P.O. BOX 9020 (ra,ctur 5uhrlY Comc•anr Des Moines, IA 50368 -9020 18160 U.S. 31 Nur l h TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number t!1 -L tf iel d, IN •160,' Y 6035 301 (317) 867 -3505 NAME CARMEL a I RLE t DEPT 34UO w 131sT ST ADDRESS WESTFTi -D M X60748267 (Sl 7,'.i 2001 CITY STATE ZIP PHONE 431 78600010 2 91 9553 04 ,102/2009 i i 1 00ciN CUSTOMER TO COMPLETE Hoy. FU,L rF; i';14 -1.00 0 44.9 P;! CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gok Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal 5116tvtal 44. sales tax exemption law of the state property as indicated below and /or purchaser is 00 Yax 0.00 indicated below and understands engaged in the business of agricultural production of Tu'Ia.1 11- and agrees with the General TSC C'+- d 44.Si food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or A, "C 6161 the applicable statement of the other agricultural production items purchased free of 11uth�t Refo: respective state printed on the tax, as defined by state law, and as indicated below. Lhanse 0'00 reverse side of this form. Cash Back PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they understand they may be liable for payment of all taxes aci(notfleds� the recc i.l t c t' STATE:, a c i E (REQUIRED) due on the purchase price for the goods as allowed by Exceptions: Georgia, New York Kentucky e Y of t; ik l' 5 .,Ile till, I'll' COMPLETE REVERSE SIDE) state law should such goods be used or consumed in a taxable manner as defined by state laws. t i p „t,rctt,. d� _.e ',hit PURCHASER IS ENGAGEDIN:(REQUIRED) BCCUrdJ Ld I r0l Ca 'C �Olde1' Ilsl E] 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 C4i11 800 96 3-0734 within 7 :jays to Livestock In estibles or In ectibles lc iC a 3ttrv•_Y and tic elt't;_1 c 'd i,l a 1 1 Exempt F-1 monthly drawins for a ch. occ' to Lain a Fertilizer /Agrichemicals NC: only DOT and US Government are exempt shori' i Resale (Sales Tax Permit 3251, a 5P r e'e F Consumed in Production (KS) (Awarded as Gift Cal d) NO FURCJJG,r' Ingredient or Component Parts (KS) OR OURVEY NECESSARY, Ends 9/1 Other: Enter Sure 0 04M CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL 2 -11 IS NOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE FA ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TM-To TRACTOR SUPPLY COMPANY SUPPLY co P.O. Box 9020 Des Moines, IA 50368 -9020 Trac'tel Sucl'lYoutF•arrt 1 C160 U 31 t;or ii, TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number ,e-34f ie ld, 1r;; 440"M 60 301# (317) 067 "3 =05 NAME CflPMEL SIT,"EL1' DE('1 3'100 1:ilSi 51 ADDRESS 6iES r IELD 1,1 460 el5267 (317) 733- 2001 CITY STATE ZIP PHONE 1 r 1 I t'^ i R f.3. f. r�0 (i L_, 04/10/203? 01: CUSTOMER TO COMPLETE >':;;T I« h G, CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: t T The undersigned certifies The undersigned party certifies their exemption from a9 i r, i'i!ri N (I;' compliance with the agricultural payment of sales and use tax on tangible personal l F• r 37 s ;f sales tax exemption law of the state property as indicated below and /or purchaser is indicated below and understands engaged in the business of agricultural production of and agrees with the General food or fiber, horticulture, aquaculture of floriculture for SuU i z i;:., 9L Exemption Statement at right and resale and/or uses the farm machinery, equipment or 0.7 the applicable statement of the other agricultural production items purchased free of f0 i '1 respective state printed on the tax, as defined by state law, and as indicated below. 7SC C-wd reverse side of this form. ncf: t U0 11 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 0 p a i ti i 2 6 understand the m be liable for p ayment of all taxes "U: �Ircr STATE: Y Y P Y (1 (REQUIRED) due on. the purchase price for the goods as allowed by W,,ii, �I (Exceptions: Geor New York Kentuck State law should such goods be used or consumed In C,; k COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) r :1 o -1 J S i tC C. C. Ut :J tit Resale Under penalty of perjury, signee swears then -1 Government Information on this statement is true and correct In CUPY 0" i tls SJ.1E'. 6t t!' ru6 i"e Niu'Lit_ _0 U Exempt organization, every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to t• Dairy Production penalty and /or other provisions as allowed under state r�,,l:r (4l 11!- C.. •',11T i';�, ,r t Livestock Production C] Floriculture /Aquaculture Production law. Other: 5� ..a�.i ut•c: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm MachinerylRepair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilize r/Agrichem icals NC: only DOT and US Government are exempt g 2 F 3 5 i R 11 c 3 3 Y 'z s E Resale (Sales Tax Permit F Consumed in Production (KS) r 1 r n n l If8 .;Y r4itil:tn tj. ,o Ingredient or Component Parts (KS) aa e t' �k �u r ;:Y ,l!I,t 6,� e'r Need F1 tin Other! l'il; t r.J f c; t't._;I' '0 it i JL.J .f Ulf t Lili I'�• I C T ER IGNATURE: (REQUIRED) MGR. APPROVAL au- x SHA USE AREA ONLY WHEN REGISTER IS INOPERATIVE. A CHE CK VISA ;M /C DISCOVER TSC CHARGE ACCOUNT NO. CHO. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99-00401 (12/05 CUSTOMER ORIGINAL ��1 REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR TRACTOR SUPPLY COMPANY SU PPLYCo P. B ox 9020 Tr ictor S f ly co, wly Des Moines, IA 50368 -9020 1&160 t1, S, 31 North TSC TEAM MEMBER TO. COMPLETE Please include 16 Dig Account Number 460? 4' 6035 301 NAME Ui)R'II:.L 3400 bj 1, ST ST WI_STTrftLU IN 560743267 ADDRESS (311,) CITY STATE ZIP PHONE 431 "931 Of)017i' 91�`ii 03/1 %''2f1Oj 02:29rr,1 CUSTOMER TO COMPLETE 0116 1 TU;J t:lb' HP I CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gcwerrrlwrit Iii, r,cie The undersigned certifies The undersigned party certifies their exemption from 0171406 Ci)ai -f 12Th{ 4G 1.p Si;lL compliance with the agricultural I •00 4 4q 4.49 NT sales tax exemption law of the state Payment of sales and use tax on tangible persona{ as indicated below and /or urchaser is Cov et'11 A junc us indicated below and understands prop p W` CfI -�E 12IN 4G RD sl" engaged in the business of agricultural production of 9 and agrees with the General ,00 L 4, 4/ 4.45 NT Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Govern�len r F},�r�nc ze 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 St1•(nta1. BZ.gd reverse side of this form. tax, as defined by state law, and as indicated below. 00" Tax 01 00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Tnfai 62.96 r Y,- understand the may be liable for payment of all taxes T. L Cr,rd 02 96 STATE: Y Y P Y f1CCt�:�'$£f03$• ",E8 sr5965 (REQUIRED) due on the purchase price for the goods as allowed by A11t1 .01933. I,ef i 91;iZ'1.37f}i3 (Exceptions: Georgia, New York Kentucky state law should s oods be used or consumed in COMPLETE REVERSE SIDE) g P9 a taxable manner as defined by state laws. C; I�Ir•�t 0 ou PURCHASER IS ENGAGED IN! (REQUIRED) i'a dC Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in e Bc ,c( t,� recE,, n; n co,rss l E) 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 cart i;i .s x17 cs cl i n ;11 F ut ._,�tst n Livestock Production F1 law Floriculture /A uaculture Production q 'rho: nw •1_haac'•Le sh01 be in Other: •_:arzJaace u;.<I flia C-t dhalcic, €d�r�eele t, 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) 8 A 3 Other: C.til 51)0 968 Or:s4 wiFtizl ci.:YS to COC11-itlt it �wr vcv opd bt: C!,ivi ed in a CUSTOMER SIGNATU REQUIRED) MGR. APPROVAL X USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE o a ITEM NUMBER DESCRIPTION Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS T0: TRACTOR SUPPLY COMPANY SU YW P.O. Sox Des Moineses, I A 50368 -9020 Tractor Supply Company 18160 U.S, 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number k!estf i.eld, IN 46074 6035 301# 317) 867 -3505 NAME CARi`IF_L STREET DEPT 3400 U 131ST ST ADDRESS UESTFIELD IN 460748267 (317) 733 2001 CITY STATE ZIP PHONE 431 786000104 1 918708 03/30/2009 03 :26pm CUSTOMER TO COMPLETE 3150244 POLY ELL 90DEG INSER CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: t .Government NT Agencies The undersigned certifies The undersigned party certifies their exemption from 3150244 POLY ELL. 90DEG INSER compliance with the agricultural payment of sales and use tax on tangible personal 1 100 8 0,99 0.99 N'T sates tax exemption law of the state property as indicated below and /or purchaser is Government Asencies indicated below and understands engaged in the business of agricultural production of 3129227 TUBING BRAIDED F'YC 1 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 3.00 R 1.29 3.87 NT Exemption Statement at right and resale and /or uses the farm machinery, equipment or Government Agencies 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. Subtotal 5.B5 reverse side of this form. 7,00% Tax 0.00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Total 5.85 STATE: understand they may be liable for payment of all taxes TEC Card 5.85 (REQUIRED) due on the purchase price for the goods as allowed by Acc t4: 3 3 3 3 3 3 3 3 3 36120 (Exceptions: Geor New York s Kentucky state law Should such goods be used or consumed In Att tht; 030028 fief t- :301 4263089 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PO 4:033009 PURCHASER IS ENGAGED IN: (REQUIRED) Change 0.00 Resale Under penalty of perjury, signee swears the Cash Back Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation Buyer acknowledses the receipt of a c.omple Agricultural Production of exemption will cause the purchaser to be subject toEd Dairy Production penalty and/or other provisions as allowed under state copy of this sales slip and the Purchase o Livestock Production r F Floriculture /Aquaculture Production law' the described merchandise shall be in Other: accordance with the Cardholder Agreement, ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Sisna titre: Livestock Injestibles or Injectibtes Exempt Organization (Entity Fertilizer /Agric a icals NC: only DOT and US Government are exempt Consumed in r e duction (KS) F] Resale (Sales Tax Permit F7 Ingrediento C mponent Paris (KS) Other: Call. 800 -966 -0734 within 7 clays to COMPlete a survey and be entered in a CUSTOME IG URE: (REQUIRED) MGR. APPROVAL X USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CA CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99- 004011 (1 tio5) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TRACTOR PAYMENTS TO: TRACTOR SUPPLY COMPANY E� PPL P.O. BOX 9020 rractoi Surf lr Coiavanv Des Moines, IA 50368 -9020 1 U. S. 31 North TSC TEAM MEMBER TO- COMPLETE Please include 16 Digit Account Number tleiatf iel.d, PJ 16074 6035 301# ("3 837 3505 NAME iCA1 ;MEL. STPLET DLF'I 3 00 131ST ST ADDRESS WE TFIEU 1;! 460 46267 (317):,3 -7001 CITY STATE ZIP PHONE A3.1 0 l 0!20 9 1 0: 1 ,srt CUSTOMER TO COMPLETE 10335;' L`IL 5V i 1 1 .00 L 2 19 2.29 111 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: GQVC TTIM0111 A ncii•_, The undersigned certifies The undersigned party certifies their exemption from 1033L"S3 LOL:Kt'ii! S,l 1: X compliance with the agricultural m 1,00 C 7 29 29 P, T sales tax exemption law of the state payment of sales and use tax on tangible personal property as indicated below and /or purchaser is G,"vCrn, "ar AstrnCies indicated below and understands engaged in the business of agricultural production of 1 t 33 -�3 LOE;i(f JN Sb 1/4 X Z 1 and agrees with the General 1,00 L 212Y '2. `L9 N'r food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Guvcl-nr,IeTI t _ncies resale and /or uses the farm machinery, equipment or the applicable statement of the 1133553 LOC1<j'•f.It SW 1! X 2 1 respective state printed on the other agricultural production items purchased free of 1 uu Z 29 Z i`t HT side of this form. tax, as defined by state law, and as indicated below. rov4:r IZIm_nt El� PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they i} 3a53 LODJ-11'1 1!4 X 2 STATE: understand the y ma y p ayment axes be liable for of all t 1.00 :2.27 2, 29 i r; (REQUIRED) due on the purchase price for the goods as allowed by 1i0v.;,•itment A�3ellc e Exce tons: Geo New York Kentucky 1 0 2:;53 LG N SQ 1 4 P 9 y state law should such goods be used or consumed in f X 2 1 COMPLETE REVERSE SIDE) oh E i 2? i i i a taxable manner as defined by state laws. 1 L'u'.e t,,; ""•;<_nc i c. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the 211OSaG H X PLUG t! 11A .L. Tf Government information on this statement is true and correct in 1 00 2 1 Exempt organization every material manner. A willfully false representation GI. v rnrnert s 0Se11L ins Agricultural Production Zl 1 r)'',; U 11CX i'LJ, A0,L;: Ti f of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other provisions as allowed under state 1.00 C 1.29 1 t; t Livestock Production Cover c.i -.Z t t A -;jeac it Floriculture /Aquaculture Production law' Other: iL is ,.1. 1 b s' ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) 7 0001. T—( r) r.10 3 1' 1. 1,x,;52 Farm Machinery/Repair Parts Government Agency (Entity 15C C ti 1 Z2 Livestock Iniestibles or Injectibles Exempt Organization (Entity r,C,: i Fertilizer /Agrichemi als NC: only DOT and US Government are exempt Att i t' :030607 Ru F 4 :3003 1 1057 Consumed in Pro uction KS El Resale (Sales Tax Permit "U 9 Ingredient or C ponent Parts (KS) C'tl 1h D. 'A Other: Buvur acknu;alcJS file r cc of a col,,, 1,_ CUST E SIGN URE:(REQ MGR.APPROVAL Co. Y E;i ':1.!I; oilt_L id ud.i iitu I ch —0 LS i( X ONLY O• CA 1 CHECK., VISA M/C DISCOVER TSC CHARGE ACCOUNT. NO. CHG. EXCH. DATE a :ITEM NUMBER DESCRIPTION UNIT PRICE Form No, 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT R1�C'�OR® PAYMENT TO: TRACTOR SUPPLY COMPANY raw ImpnY Co P.O. Box 9020 Des Moines, IA 50368 -9020 Tractor Supply Cowrany 18160 U,S, 31 Hurt„ TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf 46074 6035 301 317) 667 -3505 NAME CARREL. 5TREEI DEPT 3400 I:( 131ST ST ADDRESS UESTFII LD IN 460748267 (317) 733-2001 CITY STATE ZIP PHONE 431 431000120 1 920901 04/08/2009 01 SFfl -ln CUSTOMER TO COMPLETE /Nnri 3805344 CUTOFF UHEEL. 4 1/2x, CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 6.00 e 1 ,99 11.94 N ned certifies Cfovernment ASencies The undersigned The undersigned party certifies their exemption from 39101 MTL WE'EL 4X .045 X compliance with the agricultural payment of sales and use tax on tangible personal 12.00 p 1199 23,88 NT sales tax exemption law of the state property as indicated below and/or purchaser is r overriNent Asencies 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 Subtotal 35.82 Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00% Tax 0.00 the applicable statement of the other agricultural production items purchased free of Total 35.02 respective state printed on the tax, as defined by state law, and as indicated below. T5C Card 35.92 reverse side of this form. Acc t#: J 3 7 7 3 3 3 6120 PRODUCTIST US D IN THE FOLLOWING The undersigned party further certifies they Auth�:009680 Ref *:0812563:171 STATE: understand they may be liable for payment of all taxes PC 0:040809 REQUIRED) due on the purchase price for the goods as allowed by ChaItse 0.00 (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed In Cash Back COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Buyer acknowledses the receipt of a EOnio le Resale Under penalty of perjury, signee swears the E 15. Government information on this statement is true and correct in copy o 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 5hal l be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreement Livestock Production Floriculture /Aquaculture Production law' Other: Signature; 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 Y 3 7 t 3 8 3 3 7 3 3 3 71713E 1 E 3 3 x 6 313 3 3 7 7 7# 7 7# Call 8 30 -966 -0734 within 7 days to Ingredient or Compo nt Parts (KS) copnp le to a survey and be entered in a other: monthly drawins for a chance to win a $2500 shoa� pins spree, (Awarded as Cift Card) NO PURCHASE CUSTOMER AT E: (REQUIRED) MGR-APPROVAL h X USE,SHADED AREA -ONLY WHEN REGISTER IS IN CA CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG, EXCH. DATE DESCRIPTION UNIT PRICE 77 Form No. 99 -00401 (12!05) CUSTOMER ORIGINAL REMIT TSC BUSINE66 Aut;UUIM I TRA�C�OR® PAYMENTS TO: IF TRACTOR SUPPLY COMPANY SUPPLY CO P.O. Box 9020 Des Moines, IA 50368-9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number J60Y-1 6035301 (317) NAME ADDRESS CITY STATE ZIP PHONE 2 2 CUSTOMER TO COMPLETE 7i,',IJ:1 Fl;'.- Gli :LL! -7, -19 11 GENERAL EXEMPTION STATEMENT. CERTIFICATE OF EXEMPTION: OL i: L I The undersigned certifies The undersigned party certifies their exemption from 0; on rvICL compliance with the agricultural payment of sales and use tax on tangible personal -;0'0 40,03 NT 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 SUL i LJ I 32. 'I Exemption Statement at right and resale and/or uses the farm machinery, equipment or 7,4)T_ Tz r). "to the applicable statement of the other agricultural production items purchased free of 10 fa 1 32. respective state printed on the tax, as defined by state law, and as indicated below. T",17 Coed reverse side of this form. AL: PRODUCT IS TO BE USED IN THE FOLLOWING 14 U0 The undersigned party further certifies t hey 1 STATE: understand they may be liable for payment of all taxes T L (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) LU,A' Resale Under penalty of perjury, signee swears theel Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representati6n Agricultural Production of exemption will cause the purchaser to be subject to C112 d-2t, J.1 Dairy Production penalty and/or other provisions as allowed under state i.ul C." If ill: T1'11 0--i Livestock Production Floriculture/Aquaculture Production law. Other: JAC. ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity F Fertilizer/Agrichemicals NC: only DOT and US Government are exempt 2 2 2 2 t F Consumed in Production (KS) Resale (Sales Tax Permit L! I I GOO 0' ,7 4 'hin 7 dziv to F Ingredient or Component Parts (KS) e tc 'A �:'u; V: Y �1 rl Go I; t':l 'd in a C] Other: 1 y JI 5 1U1' a r:i'laLc i4' will a �"!al d-1 iis Gi co' d) PURCV1 CU J�om SIGNATURE: (REQUIRED) MGR. AP 2.2 L-4 X; b AREA ONLY USE §AADE EN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99-00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TRACTOR® PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLY Co P.O. Box I Des Moines, A 50368 -9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number l l if ll .•1(�1 6035 301 J7: NAME ADDRESS CITY STATE ZIP PHONE 31 2 92r.:1 o L h JF %VZ CUSTOMER TO COMPLETE CERTIFICATE OF EXEMPTION:,. GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned a certifies their exemption from compliance with they agricultural g p p 1 •i t L" t •7, 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 Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for the applicable statement of the resale and /or uses the farm machinery, equipment or 'respective state printed on the other agricultural production items purchased free of j pq r art; �T reverse side of this form. tax, as defined by state law, and as indicated below. -•,nrJiry,- r jr 1 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes Ciodcr i1,ar ftscll _.ic (REQUIRED) due on the purchase price for the goods as allowed by 3 „i r 1 Y I _�_r (Exceptions: Geor New York a Kentucky state law should such goods be used or consumed in (,r: r' COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears the u Government information on this statement is true and correct in I Exempt organization every material manner. A willfully false representation Agricultural Production' of exemption will cause the purchaser to be subject to 7 C, F1 Dairy Production p enalty and /or other p rovisions as allowed under state F1 Livestock Production p y p Floriculture /Acluaculture Production law' Other: I'L t0 ilGi ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Lilt H.0 Farm Machinery/Repair Parts Government Agency (Entity CO ti °,1: ::nu. +f.Q3;� E] Livestock Injestibles or Injectibles E] Exempt Organization (Entity ;ilc` 1't.. iPi t. i' Fertilizer /Agrichemicals NC: only DOT and US Government are exempt urY �r iit Laic; �I,� It1_ h;t•'_I1.�� Consumed in Prod tion (KS) E] Resale (Sales Tax Permit 6 1u '1c�JC', iLUd n. i ci'. ridi :e -L;; 1.1 L:' :i o Ingredient or Co onent Parts (KS) 1•th i:l" F1 Other: _Q� r, I CUSTO SI A RE:(REQUIRED) MGR. APPROVAL v USE SHADED AREA ONLY CAS CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE QUANTITY ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) a ll, CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY CO P.O. Box 9020 Des Moines, IA50368 -9020 T "j�•lul` !t_I''r.1.� Ccttra.t: C3.ri'v 31 P�rteSFl TSC TEAM MEMBER TO COMPLETE please include 16 Digit Account Number %2;� (H ield, IN 4607 8035 301# ('17) 867 -3505 NAME CI?RMEL STREET DEPT 3400 131ST 5 1 ADDRESS WEsTf'1E1._U T3' 0f4Lt�f (wll 733 -2001 CITY STATE ZIP PHONE •151 4:Si000f79 2 1191.'•1 04/01 /2009 02: 24!1'16 CUSTOMER TO COMPLETE ;39 1 3SE FUEL TAIK W 4 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1.00 faDa�e e 1 1. r nu;r iri f�s n 44. Y 01 uts_ The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal' SuhtDtai 14,99 sales tax exemption law of the state property as indicated below and /or purchaser is ?.00Z. Tax 0100 indicated below and understands Total 4499 and agrees with the General engaged in the business of agricultural production of g food or fiber, horticulture, aquaculture of floriculture for CSI: Card 44.9 Exemption Statement at right and Acct':tttrtttttttav916 resale and/or uses the farm machinery, equipment or the applicable statement of the AuthY :00169 Ref m111324060s respective state printed on the other agricultural production items purchased free of f "0 ;truck i 4 reverse side of this form. tax, as defined by state law, and as indicated below Char+sp 0.0'� The under art further certifies the Cash Bac PRODUCT IS 70 6E USED IN THE FOLLOWING 9 p ar t y Y STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Buyer acknowledse:, the DF a c frlc (Exceptions: Geor New York a Kentucky state law should such goods be used or consumed ins d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. cUPy of this sales Mil' ignd tfle Pllt'! i _t_* 0 PURCHASER IS ENGAGED IN: (REQUIRED) t he described IiEr:_hZ1I1fj1.5E 51 be r!t F] Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in accordance wish [aa Cat dhulde fdttrt:cevuo; 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 Saslta (uht' Livestock Production Floriculture /Aquaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) S ?SErL8tSi :$3SS833? Farm Machinery /Repair Parts Government Agency (Entity )L3tS$Sttgt;g�g #;g;gr; ;t•rt8t3i Livestock lnjestibles or lnjectibles Exempt Organization (Entity L` t l •l 800 6+3 -0 ?3 within I' da)'S t,a Fertifizer /Agrichernicals NC: only DOT and US Government are exempt cw .Plete ti _wyw"'r arld be enierpJ ill cI Resale (Sales Tax Permit +ttvnthly dt' tt'lins for a chance 't0 tt.n i- Consumed in Production (KS) $2500 5hoi -p Llt'. 5prlee Ingredient or Component Parts (KS) (Awnrdtd as Gif* Ca( NO PURCHASE Other. CiR SURVEY NECESSARY, Lnd5 9/30/0', rt. 3Yittt8II84 .8:1Y:;�S88�>TA�E &�339b3xtHaS CU R SIGNATURE: (REQUIRED) MGR. APPROVAL X USE e o• CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. GHG. EXCH. DATE NUMBER ITEM. DESCRIPTION UNI PRI Form No. 99 00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 1 PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLY COM P. O. Box 9020 Des Moines, IA 0368 -9020 T U1 U.S. Cu th 18160 U.S. 31 P1u, tit TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number t f it !d, Ira 1 1, 6035 301 317) 8( 3505 NAME CARMEI. 5 FREET DLF' 1 3400 U 1 315T Sr ADDRESS 11L51F IELJ 1(: 4 4E;:�u (317) 733 -200i CITY STATE ZIP PHONE 431 ?960000, "M'. L 04/10/2009 09:18aw CUSTOMER TO COMPLETE 02U' CLEtf t SL11' CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT, 1 Gover+,nen AsEr ue-, t The undersigned certifies The undersigned parry certifies their exemption from 0268030 CLEViS 1i2IN If t -i 1' compliance with the agricultural payment of sales and use tax on tangible personal 1.00 7 7 .7; sales tax exemption law of the state property as indicated below and /or purchaser is Guver aiiwti t A i.AnC i0s 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 Subtotal 13, St.. Exemption Statement at right and 7.00% To, C resale and /or uses the farm machinery, equipment or the applicable statement of the t•atal 15.50 respective state printed on the Other agricultural production items purchased free of TSC Cal ri 15, L' reverse side of this form. tax, as defined by state law, and as indicated below. a PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they AI.c11i :010137 R(.ta:1W'2175874 STATE: understand they may be liable for payment of all taxes PO t;: J:, (REQUIRED) due on the purchase price for the goods as allowed by chance 0.00 (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 We Government information on this statement is true and correct in CUPY U1 th; galas- I;• a+t.j die r'u, i2 Exempt organization every material manner. A willfully false representation El Agricultural Production of exemption will cause the purchaser to be subject to I 1e ILL, J C, ,•1,. �,L Dairy Production penalty and /or other provisions as allowed under state accU; uceoce os_ ti1C C- ,rw,Ul��; Livestock Production Floriculture /Aquaculture Production law' Other. Sis.latu, e ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injestibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Resale(SalesTaxPermit# >,s3$t8s338;8d;38S iS3 i'a Consumed in Production(KS) Call 800 -968 0734 uithln 7 days t0 Ingredient or Component Parts (KS) calm lete t ury and be entered in �i raunthlr drawins fon a Cltar+c_e 10 win Other. 4 shuoPins spi-ee. (AwardeJ a5 Gi'fi Card) NO PU: CUSTOMER SIGNATU�RE�D) MGR. APPROVAL X USE AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER NON DESCRIPTIO TAX Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY 1 LY CO 11111110 P.O. Box 9020 Des Moines IA 50368 -9020 I' U 1 I L C Ao ill 1i.".G:i E, 5 I7�riii TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number li: _tit. <•I.). ',�ar: 6035 301 1 NAME dY00 i•1 i ;1ST ADDRESS I CITY STATE ZIP PHONE 13', 71 I `.'?1 s;• 04/ 1 u•'2U05' 'J7 t Zan CUSTOMER TO COMPLETE ;;'i i 5 r CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: G:•,e; 1, en t A_ 1t1_ir 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 i' 1 ;4s 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 1,�{' 1'' c? 1 4,iW NH resale and /or uses the farm machinery, equipment or the applicable statement of the X, 2 1 respective state printed on the other agricultural production items purchased free of uovisrnrler.'r ia��nci.es reverse side of this form. tax, as defined by state law, and as indicated below. 2 r r3 22,�L Bluck T i;UCi; ,Iui: PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 1100 17 id'( STATE, understand they may be liable for payment of all taxes Gu::_r u, Ln i (REQUIRED) due on the purchase price for the goods as allowed by 222 9278 LUCKI_I' 11U FIGN (Exceptions: Georgia, New York Kentucky state law should such goods be used or Consumed In I UG i 7, 1 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 01iVei 0- 1 L.r PURCHASER IS ENGAGED IN: (REQUIRED) 411 111 t _7 n^ Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in u. _t(: Exempt organization every material manner. A willfully false representation I i i a 1 U;' Agricultural Production of exemption will cause the purchaser to be subject to Ca,•.i a Dairy Production Acc F<.3' ^tx 2':2-59(1; penalty and /or other provisions as allowed under state Livestock Production law Au flh'�.: 71 Floriculture /AquacultureProduction lo,: 0 r'. Other: C.i.,n ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injestibles Exempt Organization (Entity u t' i i l i ;1. 71 i .:-C: i i !L r n VC. E a Fertilizer /Agrichemicals NC: only DOT and US Government are exempt t l� U1:.l I�V'� 1. {�l•L,iic, 1. .i 1. �L' �l1aI1 u� l.IS Consumed in Production (KS) Resale (Sales Tax Permit �iecorJan�_e al ±.'rh rli2 C�• +iit�I[ier Asree :._I� f Ingredient or Component Parts (KS) Other: 5i�a!tuhc CUSTOMER SIGNATURE: (REQUIRED) MGR. APP AL X USE AREA ONLY CASH CHECK VISA WC DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLY P.O. Box 9020 Des Moines, IA 50368-9020 lulc*'o U. Ku.' h TSC TEAM MEMBER TO COMPLETE Please idclude 16 Digit Account Number (6035 301 NAME bi:JLI_ U!_!'! ADDRESS CITY STATE ZIP PHONE CUSTOMER TO COMPLETE 31;91'"() CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT The undersigned certi The undersigned party certifies their exemption from 144100.1 1'1'1 C&,'TP0L Ui't compliance with the agricultural payment of sales and use tax on tangible personal I 0 t^ 1 "I'll 01 sales tax exemption law of the state property as indicated below and/or purchaser is GUV 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 Sub i U a 1, 0 0 Exemption Statement at right and resale and/or uses the farm machinery, equipment or 0' O.'� f'; 0.0) the applicable statement of the other agricultural production items purchased free of Total respective state printed on the tax, as defined by state law, and as indicated below. TSC Cavd reverse side of this form. I-) L C i J 1, o u120 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they il'u "I'� 01 J- r Po 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) L, Resale Under penalty of perjury, signee swears Government information on this statement is true and correct in and 1 11', Cl Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to tI)d dt I ib_1 I`W) 1;1;' Jil Dairy Production penalty and/or other provisions as allowed under state dAIILL U ttt 7 i L: 4111' F Livestock Production Floriculture/Acivaculture Production law. Other: Sis"c. "Ll' t- ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity NC: only DOT and US Government are exempt .1 F 8 3 2 8 t t Fertilizer/Agrichemicals F Consumed in Iroction (KS) Res (Sales Tax Permit C'A i t U00 768 jithi 7 day, to 0 Pon '.�LII'VtY 6 11 F1 Ingredient or ent Parts (KS) LOMIAL 1 awo t it I Y dir aw i it f ur a chance I o wi,i a Other: $2500 Itho-rinb !,ervc. (Auu as GifL Card) "d P0C14P,'i: CUSTO IGN URE::(REQUIRED) MGR. APPROVAL 2-16, X USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. =ASH CHECK VISA MIC DISCOVER TS CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTION Form No. 99-00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR TRACTOR SUPPLY COMPANY SUp�I,YC0 P.O. BOX 9020 1 1 r Cu lr ull r Des Moines, IA•50368 -9020 t,t TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 6035 301 NAME (riiCi{EL c l i. i 1 L I 314 0 1 I T 1 t,ES11 i:LD 14 1f: 01';82;',' ADDRESS (31 j� 21!01 CITY STATE ZIP PHONE 431 71740001 i' ;7' n4.$ CUSTOMER TO COMPLETE azG 37' i,Yl'!r; iA1:" :ar DY il 1 .00 L- 24.9`r' 2$.99 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: G,,:-2)nilwnt Ajeu s The undersigned certifies The,'undersigned party certifies their exemption from '12.71 r r1 1;? dK CLi:ANF:'Z ;d r compliance with the agricultural 15,`" '!r payment of sales and use tax on tangible personal 1 0 Cuvu,. r,te, Ii3ertL iLS 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 'tbiut.i 30,9, food or fiber, horticulture, aquaculture of floriculture for n ,tr Exemption Statement at right and resale and /or uses the farm machinery, equipment or Totitl 40.70 c respective state printed on the g production 1SC Card the applicable statement of the other agricultural items free of f r -4 reverse side of this form. tax, as defined by state law, and as indicated below. y r •,3 s Z Z: a 1601:5 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they RL; to "15201 f ;e E c 50 "5 h3756 understand the may be liable for payment of all taxes 18 1 SU9 STATE: i'1 rG Y Y P Y Chatl3e 0.00 (RE UIRED 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. l �u.YC•i' ,tCl�'aJ'.JZc''.:�5 i +tC a'_LUi; Oi ii �!!ai; l PURCHASER IS ENGAGED IN: (REQUIRED) [3 Resale Under penalty of perjury, signee swears th`e of ilti.� :ialLS '�.t a,;d t111-- I IrL t,; e I' Government information on this statement is true and correct in LOP F] Exempt organization every material manner. A willfully false representation Agricultural Production i, i1L' c, iueii ..;r'Ptir ut>ii °u a,,.,tl in 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: 5'i�nal'ure: ITEMS PURCHASED WILL BE USED FOR (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /A nchemicals NC: only DOT and US Government are exempt t 3 3 2 Consumed in Production (KS) Resale (Sales Tax Permit Call 803 within 7 d€ 'cu Ingredient or Component Parts (KS) Lur.;riete a survey and Le unturcd in a 111100thlY u:awiUS fug it th1)VLC 10 win C. Other: X2500 shavoii1:j Jaree• (Award: as Gif C.+ 'd) NO PU!11 1 JE CUSTOMER SIGNATU E• OU E MGR. APPROVAL USE SHADED AREA l X ONLY CASH CHECK M/C DISCOVER TSC CHARGE ACCOUNT NO, CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO 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)) 04/22/09 900125540 $176.40 05/04/09 $91.81 05/04/09 $481.93 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 NG. WARRANT NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $750.14 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 r 900125540 42- 370.00 $176.40 1 hereby certify that the attached invoice(s), or 2201 42- 389.00 $91.81 bill(s) is (are) true and correct and that the 2201 42- 370.00 x $459-93 materials or services itemized thereon for which charge is made were ordered and l received except T�i rsd a 07, 2009 APA �t Title Cost distribution ledger classification if claim paid motor vehicle highway fund