169648 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
ONE CIVIC SQUARE TRACTOR SUPPLY CO
CHECK AMOUNT: $531.89
CARMEL, INDIANA 46032 PO BOX 689020
DES MOINES IA 50368 -9020 CHECK NUMBER: 169648
CHECK DATE: 3/4/2009
DEPARTMENT ACCOUNT P NUM BER INVO NUM AMOUNT DESCRIPTION
2201 4356001 STREET 531.89 6035301200050860
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page 1 of 4 Tx 7 Dn300r00000 1�y�
S T W Y V 2
BUSINESS ACCOUNT
0000362
AGC�+QUidT �aIJIViM/�►RY 643 3012Q4Q�,Q�� :R�
x��t:a�`r t .<rs�'� :..?rP n:ura� iii
Previous Balance 1,762.21 Closing Date 02/18/09
Payments 1,240.11 Next Closing Date 03/19/09 CARMEL STREET DEPT
Credits 0.00 Payment Due Date 03/15/09 CINDY
Purchases 537.49 3400 W 131ST ST
Debits 0.00 Current Due 537.49 WESTFIELD, IN 46074 8267
FINANCE CHARGES 0.00 Past Due Amount 522.10 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 1,059.59 Credit Available 4,190
New Balance 1,059,59
CURRENT ACTIVITY
rans�a�cUon LocatioM Amount
pate a Aescr�ptiQn r k� w
JAN 27 GOODS AND SERVICES WESTFIELD IN 8.79
TOTAL 6035301200074803 $8.79
JAN 26 GOODS AND SERVICES' ;.NDBLESVILLE IN 18.18
JAN 26 GOODS AND SERVICES"NOBLESVILLE IN 69.97
TOTAL 6035301202895890 $88.15
JAN 30 GOODS AND SERVICES WESTFIELD IN 159.98
FEB 12 GOODS AND SERVICES WESTFIELD IN 79.99
TOTAL 6035301202895924 $239.97
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL
subject to Periodic Billing PERCENTAGE Subject to Periodic &Ihrg PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN 0.00 .00000 29 0.00 0.00 00000 33 0.00
This Account Issued by Citibank (South Dakota), N.A. CUSTOMER SERVICE 1- 800- 559 -8232 FAX NUMBER 1 -801- 779 -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 per iod- 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
subiect to the Promotional Balance Exceptions), plus the minimum monthly billing period by its daily periodic rate. If your account is subject to a daily
F ayments 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 11 /b 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 ail 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 billing
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 clue date. for that billing period. We do not calculate periodic finance charges for the
previous billing period if your account was credited for the full New Balance,
Certain promotional offers may take away the grace period on purchases. plus the minimum monthly payments required for your No Interest and 0%
Other promotional offers may allow you to have a grace period or) purchases balances, on your previous billing statement by that statement's payment due
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
number of days in the billing period and by the applicable daily periodic raise
separately for each balance. Balances include regular purchases, regular cash
advances, and different promotional balances. The result u the periodic finance charges for that balance. For each purchase
valance, 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 thing 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 nev: transactions). We figure the periodic finance charge by Notify Us in Case of Errors or Ouestions About Your Bill. If you think your
multipl the daily balance by its daily per rate. We do this for each day bill is wrong, or if you need more information about a transaction on your bill,
in the Nlknq period. The Balance 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 daily 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 Sub ect to Finance Char Calculation Meth If the a The dollar amount of the suspected error.
front of your statement as 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 fee 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
proper Pay b Phone Service. y by phone, You will be charged $1495 to use this e serry service, Call by 5 to make a
payment we receive that is not in ro sr form or is not sent to the correct
address. The correct address for a payment sent by regular mail 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. Express Payments. You can send payment by courier or express mail to
Proper Form. For a payment sent by mail or courier to be in proper form, you the Express Payments Address: Customer Service Center, Dept, CCS 911,
must: 4740121st Street, Urbandale, IA 50323. Payment must be received in proper
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. You 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 5603TV Rev. 07108
soon as the day we receive the check. Also, the check will be destroyed. 603TV5740703 -Cif
page 2 of 4 TX 7 DI130
�P
®a "WI/
BUSINESS ACCOUNT
�0 0000363
�Y
CURRENT ACTIVITY
Transaction��� x o atianl
4 �at@ Dsscripilon -h ,...,,mss;. z r ..t M
JAN 20 GOODS AND SERVICES WESTFIELD IN 114.98
TOTAL 6035301202895932 $114.98 n
JAN 20 GOODS AND SERVICES WESTFIELD IN 85-6
TOTAL 6035301202896096 $85.60
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
JAN 23 PAYMENT REF P9194000T09JXX60S 1,240.11
Continued non payment may affect your
ability to purchase on credit. Protect
this privilege by sending payment today.
This account is subject to the Alternate Balance Subject to Finance
Charge Calculation Method. See back for details.
b�
I'
Remit To: Bill To: page 3 Of 4
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860
DEPT.30 1200050860 JEFF STEWART 7SUMYCO2,
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000364
Payment Due Date: 03115/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SNIP TD: INVOICE: SHIP TG: INVOICE:
431000904958010 624001082336010
Purchase Order: Purchase Order:
12709 12609
AMOUNT DUE: 8.79 AMOUNT DUE: 18.18
Stores: 514000451 INVOICE DATE: 01127 /09 Stores: 574000624 INVOICE DATE: 01/26/09
HOSE 3 /8X10FT SPRAYER E 2112667 1.00 8.79 8.79 SPECIAL ORDER PAYMENT 624052728 1.00 18.18 18.16
SUBTOTAL 8.79 SUBTOTAL 18.18
TAX 0.00 TAX 0.00
SHIPPING 0.00 SHIPPING 0.00
TOTAL 8.79 TOTAL 18.18
1 I
V
SHIP TO: INVOICE: SHIP TO: INVOICE:
624001082331010 431000905488010
Purchase Order: Purchase Order:
12609 KRISTIKRYSTALPARKS
AMOUNT DUE: 69.97 AMOUNT DUE: 159.98
Store: 574000624 INVOICE DATE: 01/26/09 Store: 574000451 INVOICE DATE: 01/30 /09
JKT ARCTIC BLK 42T 6420397 1.00 69.97 69.97 SHOE CHORE HI BK 10 SN6 7015137 1.00 79.99 79.99
SHOE CHORE HI BK 8 SN62 7015111 1.00 79.99 79.99
SUBTOTAL 69.97
TAX 0.00 SUBTOTAL. 159.96
SHIPPING 0.00 TAX 0.00
SHIPPING 0.00
TOTAL 69.97
TOTAL 159.98
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425
Remit To: Bill To: Page 4 of 4
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 R
DEPT.30 1200050860 KRISTI SNYDER ®SUPnYCO
PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT
DES MOINES IA 50368 -9020 0000365
Payment Due Date: 03/15/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP T INVOICE:
431000908142010 431000903569010
Purchase Order: Purchase Order:
21209 FOUNTAIN
AMOUNT DUE: 79.99 AMOUNT DUE: 114.98
Store: 574000431 INVOICE DATE: 02/12 /09 Store: 574000431 INVOICE DATE: 01/20 /09
SPECIAL ORDER ARTICLE 0222220 1.00 79.99 79.99 SHOE CHORE HI BK 9 SN62 7015129 1.00 79.99 79.99
STALL MAT 4X6 RUBBER 2219003 1.00 34.99 34.99
SUBTOTAL 79.99
TAX 0.00 SUBTOTAL 114.98
SHIPPING 0.00 TAX 0.00
SHIPPING 0.00
TOTAL 79.99
TOTAL 114.98
i
J
SHIP TO: INVOICE:
431000903570010
Purchase Order:
FOUNTAIN
AMOUNT DUE: 85.60
Store: 574000431 INVOICE DATE: 01/20 /09
SPECIAL ORDER PAYMENT 431052091 1.00 85.60 85.60
SUBTOTAL 85.60
TAX 0.00
SHIPPING 0.00
TOTAL 85.60
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SU Y CO P.O. Box 9020
Des Moines, IA 50368 -9020 1 81 60 U.S. 31 t ur th
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (s i ".>'I ,rt '•u` 'f
867- 35t1.�
6035 301 (517)
NAME I CriRriLL 51 R"E 1 DE PT
3400 J 131 51 ST
ADDRESS
liEw I'f 1ELD IN •160748267
5�i -2141
CITY STATE ZIP PHONE 43 1 431 Goo 179 9t)
01/27/200 91 4`Irfil
CUSTOMER TO COMPLETE 2112667 1 U; L LjX10E jcpV,ryF
1.00 2 8.79 8.7`,' N1'
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. 6uvernoeni Asencies
The undersigned certifies The undersigned party certifies their exemption from
compliance with the agricultural payment of sales and use tax on tangible personal Subtplal 8 7:
sales tax exemption law of the state property as indicated below and/or purchaser is 7' C0Z 0.06
indicated below and understands engaged in the business of agricultural production of T 8.79
and agrees with the General SC Ciwd
food or fiber,horticulture,aquaculture of floriculture for ACCta:$at$$$?1:tttc 0 8,'7
Exemption Statement at right and �i0$
the applicable statement of the resale and /or uses the farm machinery, equipment or Rt_; #:77 12441454
respective state printed on the other agricultural production items purchased free of rt1 6:012709
reverse side of this form. tax, as defined by state law, and as indicated below. ChZkI19c
0, 01,
The undersigned art further certifies the Cash B„r
PRODUCT IS TO BE USED IN THE FOLLOWING g p Y Y
STATE: understand they may be liable for payment of all taxes Buyer acknawledse5 the t eceiwt. Df rt L 1
(REQUIRED) due on the purchase price for the goods as allowed by,
(Exceptions: Georgia, New York Kentucky state law should such oods be used or consumed in
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. C °r r' of t1tL3 sal r_. ',I i �,ttv tilt °urci�_tse o
PURCHASER IS ENGAGED IN: (REQUIRED) the de5cribed t1IL"'c landise Shill be in
Resale Under penalty of perjury, signee swears the .kcrnn'd, +Ice wltii the Cardl`IDld=r Asree,ilent,
F1 Government information on this statement is true and correct in
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the p urchaser to be subject to
F Dairy-Production I r�'t.?T
Livestock Production penalty and /or other provisions as allowed under state
[I law. Floriculture /Aquaculture Production
Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
,Farm Machinery/Repair Parts Government Agency (Entity
Livestock In estibles or In ectibles ,x l l 130t: `9 _o X31 k i (i i.It 7 dil to
E] Livestock j Exempt Organization (Entity
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Cratdr lets a survey and be en t'ered in a
acrn2111Y
Consumed in Production (KS) E] Resale for Lhan+_e fo kill a Resale (Sales T a x Permit $2500 stkw r i n S 5W r ee
Ingredient or Component Parts (KS) (Awat' as Gift CArd) NO PURCHASE
OR SURVEY NECESSi)RY, Ends 9130'09,
F Other:
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
X
SHA DED USE ONLY.WHEN REGISTER IS INOP ERATIVE.
CASH CHECK VISA MIC DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
ITEM NUMBER DESCRIPTIO
Form No. 3e 00401(12105) CUSTOMER ORIGINAL
REMITTSC BUSINESS ACCOUNT
17 T RA CTOR PAYMENTS T
TRACTOR SUPPLY COMPANY
,UYC® P.O. Box 9020 Tr actor 5t.tt P.iy rOilipanY
Des Moines, IA 50368- 9020 2375 Gast Pleasant St.
TSC TEAM JWEMBER TO COMPLETE Please include 16 Digit Account Number noble ='vil le, IN 46060-
6035 301 B 17) 776 188
NAME 624 624000070 1 1082336
01/26/2009 02:33pw
ADDRESS
ttt SPErfAL ORDER CONTRA ttx
Special Order #:.6'24052728
CITY STATE ZIP PHONE CARMEL S rREE t Dl :'P
3400 W 131ST ST
WESTFIELD IN 4607482.67
CUSTOMER TO COMPLETE (317) 571 -42141
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT 0222220 BLK HOOD
The undersigned certifies The undersigned party certifies their exemption from 1 .00 0 18.18 18.18 NT
compliance with the agricultural payment of sales and use tax on tangible personal Government Asencies
sates 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 Subtotal.
and agrees with the General 7.00% Tax 0.00
food or fiber, horticulture, aquaculture of floriculture for
Exemption Statement at right and fatal 18.19
resale and /or uses the farm machinery, equipment or
the applicable statement of the Deposit 18.18
respective state rinted on the other agricultural production items purchased free of TSC Card 18,18
reverse side of this form. tax, as defined by state law, and as indicated below. Ac r t t t t 4 i t #5890
The undersi ned art further certifies the Autht:026059 Reft:2613333306
PRODUCT IS 70 D NTHEFOLLOWING par y PO (:012609
srnrE: understand they may be liable for payment of all taxes
IRE 5WMIRE due on the purchase price for the goods as allowed by Chance 0.00
(Exceptions: Gef5rgia, New York Kentucky state law should such goods be used Or consumed In Cash Rac
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws. BALANCE DUE: 0,00
PURCHASER IS ENGAGED IN: (REQUIRED) Buyer acknOwledses the receipt of a COmPII'
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in- f
Exempt organization every material manner. A willfully false representation covy of this sales slip and the Purchase o
Agricultural Production of exemption will cause the purchaser to be subject to
Dairy Production penalty and /or other provisions as allowed under state this described merchandise shall be in
Livestock Production law accordance with the Cardholder Asreentent,
Floriculture /Aquaculture Production
Other:
Sisnatur�:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Iniestibles or Injestibles Exempt Organization (Entity
[J Fertilizer /Ag riche micals NC: only DOT and US Government are exempt
Resale(SalesTaxPermit#
E] Consumed in Production (KS)
Ingredient o Cotpp nent Parts (KS) Call 800 -968 -07:54 within 7 days to
Other: r"' complete a survey and be entered in a
monthly drawins for a chance to win a
$2500 shoppins spree,
�ERSIGNATU :(REQUIR MGR. APPROVAL (Awarded as Gift Lard) NO PURCHASE
OR SURVEY NECESSARY. Ends 9/30/09.
X
USE Sl
CASH
CHECK -VISA r. M /O° .DISCOVER. 'TSC CHARGE ACCOUNT NO. CH G. EXCH. DATE
O
LINIT PRICE,
ITIEWNUMBER
Form No. 99 -00401 (12105) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
JU TE MEMNON TRACTOR SUPPLY COMPANY
MUMT rqww CO P.O. Box 9020 Tractor Suerty Coiipany
Des Moines, IA 50368-9020 2375 East Pleasant St.
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville,'[N 46060
NAME
3400 W 1116T ST
ADDRESS WE!31'FIELD TN 460748267
CITY STATE ZIP PHONE
624 624000070 1 1082331
CUSTOMER TO COMPLETE 6420397 JK1 ARCTIC RLI' 42T
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res. Prif-e: 99.96
The U ncle,signed ce rtif ies The undersigned party certifies their exemption from Govertokeiit Asencies
compliance with the agricultural payment of sales and use tax on tangible personal
's lax ex:mplion law of the state property as indicated below and/or purchaser is Subtotal 69.97
indica low and understands engaged in the business of agricultural production of 7.00% Tax
land agrees wit h, the General food or fiber, horticulture, aquaculture of floriculture for r a t a 1 69 .97
Exemption Statement at right and resale and/or uses the farm machinery, equipment or TSC Card 69,97
the applicable St4tement of the
respect1v state I rinted on the other agricultural production items purchased free of Acct$:4*;%*2***t1J5990
I e e of thi� tax, as defined by state law, and as indicated below. Authi::026347 Reft:2613275580
reverse Sid form. PO #:012609
PRODUCT Is TTAE IN THE FOLLOWING The undersigned party further certifies they Chanse 0100
STATE: understand they may be liable for payment of all taxes Cash Back
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 111-tyer acknowledsf?5 the eoceipt of a c
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. t(d
PURCHASER IS ENGAGED IN: (REQUIRED) copy of this sales slip and the Purchase m
F Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in thp described literrhandise shall be in
Exempt organization every material manner. A willfully false representation accordancewith the Car Agreement.
Agricultural Production of exemption will causethe purchaser to be subject to
F Dairy Production penalty and/or other provisions as allowed under state
F1 Livestock Production
E] Floriculture/AquacuJture Production law. Signature:
LJ Other:
ITEMS PURCHASED WiLL BE USED FOR: (REQUIRED)
F Farm Machine ry/Repair Parts E Government Agency (Entity
Fl Livestock Iniestibles or Injectibles Exempt Organization (Entity
D Fertilizer/Ag rich em ica Is NC: only DOT and US Government are exempt Call 800-968-0734 within 7 days to
El Consumed in Production (KS), E] Resale (Sales Tax Permit complete a survey anti be entered in a
otheri
(Awarded as Gift Card) NO PURCHASE
OR SURVEY NECESSARY, Ends 9/30/09,
)U(ST- IMER 89 EQUIRT� MGR. APPROVAL
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH CHECK VISA MIC DISCOVER JTSC CHARGE ACCOUNT NO-, CHU. EXCH, DATE
ITEM BER DESCRIPTION UNIT'PRICE
NUM
Form No. 99-00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
1111101[ PAYMENTS TO:
TRACTOR SUPPLY COMPANY
SUI%YCO P.O. Box 9020 Tractor SulsrlY Canteany
Des Moines, IA 50368 -9020 18160 11,S. 31 Norih
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wtstf ield, IN 460(4
6035 301# (317) 867--3505
NAME CARMEL STi'1LE.1 DEPT
3400 W 131ST 51' 0�
ADDRESS WESTFIELD IN 4607AD267
(311) 571 -2141
CITY STATE ZIP PHONE 431 431000181 L 905488 rAY�
01/30/2009 09.43,m,
CUSTOMER TO COMPLETE 701 5137 SHOE CHORE Hl BK 10
1,00 0 1 9 ,99 79.99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: G0Vernmmn1 AsEUcie5
The undersigned certifies The undersigned party certifies their exemption from 7015111 SHUE CHUiiC HT H 8 S
compliance with the agricultural payment of sales and use tax on tangible personal 1.00 79,99 79,99 NT
sales tax exemption law of the state property as indicated below and /or purchaser is Gcver Intent Aseticies
indicated below and understands engaged in the business of agricultural production of
and' agrees with the General Subtotal 159,90
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 159,90
respective state printed on the other agricultural production items purchased free of TSC Card 159.9(3
reverse side of this form. tax, as defined by state law, and as indicated below.
The under art further certifies the AuthO :030049 R'2ty:3008424024
PRODUCT IS TO BE USED IN THE FOLLOWING g p y y
STATE: understand they may be liable for payment of all taxes [-'(1 #k 1ti' i5 t 7.1tr Y9 l iilPar kS
tREQU,RED) due on the purchase price for the goods as allowed by Change 0.00
(Exceptions: Georgia, New York Ke ntucky state law should such goods be used or consumed in Cash Rack
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED) 3ltyer acknowledsts the receii't Of a conTlc
Resale Under penalty of perjury, signee swears the`' f
Government information on this statement is true and correct in COPY Of t ,hi5 Sales siir and the Purchase D
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to tht, described merclrartdi5e shalt t. ,e in
Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreemen t
Livestock Production
F1 Floriculture /Aquaculture Production law'
Other: 5isnature;
ITEMS PURCHASED WILL BE USED FOR: REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles Exempt Organization (Entity
Fertilizer /Agrichemicals INC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit Call 800 968 within 7 daY9 to
Ingredient or Component Parts (KS) celmplete a survey and he entered in ra
monthly drawins 1Dr a chRnce to win a
F] Other: $2500 shoerins Spree,
(Awarded as Gift Card) NO PURCHASE
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
I X
USE AREA ONLY
CASH CHECK VISA M1C DISCOVER TSC CHARGE ACCOUNT N0. CHG. EXCH. DATE
ITEM NUM BER DESCRIPTIoN UNIT PRICE
in c�
R
d
Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL
Operations Center 2/25/2009 8:09 AM PAGE 2/002 Fax Server
CHARGED BY:
MAIL PAYMENTS TO: GARY JONES
TRACTOR SUPPLY 211 2ND ST SW
P.O.BOX 689020 211 2ND ST SW
DES MOINES IA 50368 -9020
CARMEL IN 46032 -2014
MAKE CHECKS PAYABLE TO: TRACTOR SUPPLY
PLEASE INCLUDE ACCOUNT NUMBER ON CHECK TO ENSURE PROPER PROCESSING
ACCOUNT NO *4811
P.O. NO WINTERCOAT
INVOICE NO 431000900390010
INVOICE DATE 01/05/09
INVOICE AMT 79.99
CHARGED AMT 79.99 AMOUNT YOU PAY
DESCRIPTION S.K.U. QUANTITY PRICE EXTENSION
COAT SNDSTN XL CHOC C 7134567 1.00 79.99 79.99
SUBTOTAL: 79.99
TAX: 0.00
SHIPPING: 0.00
INVOICE TOTAL: 79.99
DIRECT INQUIRIES TO
SERVICE REP: 1- 800 -559 -8232
FAX:
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
)W TP='WR TRACTOR SUPPLY COMPANY
SUPnyC2 P.O. BOX 9020 Tractor .tl ei Cofkwany
Des Moines, IA 50368 -9020 18160 +J,S. 31 Not th
TSC TEAM, MEMBER TO COMPLETE Please include 16 Digit Account Number
6035301 (317) C 67 -3SOS
NAME t,wf c;T' 1)l•(''
5400 W 1 S (ST ST
ADDP—ISS WESTr1LLD TI'S 46r' *'48261'
t31Y) 571 -2141
CITY STATE ZIP PHONE 4s1 431000172 2 90356
01/20/200' 09 23alti
CUSTOMER TO COMPLETE 7015129 SOE C:aJ;<F i-il Bit 9 3
1,00 L 79,99 FV,99 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gove nment F.5cliC]e5
The undersigned certifies The undersigned party certifies their exemption from 221"Q2 GTi,LL ;'EAT 4Xc, i1:!JSBEi2
compliance with the agricultural payment of sales and use tax on tangible personal 1 00 2 31,97 34.59 NT
sales tax exemption law of the state property as indicated below and /or purchaser is Gover rule n t Aseiic ies
indicated below and understands engaged in the business of agricultural production of
and agrees with the General subtut;xl 114.98
Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for 7.00:: Tax 0.00
the applicable statement of the resale and /or uses the farm machinery, equipment or l 114.
respective state printed on the other agricultural production items purchased free of (SC Gird 114.98
reverse side of this form. tax, as defined by state law, and as indicated below. Acs t y x59u2
The und art further certifies the Ao Hy :020461 R P 2002234241
PRODUCT IS TO BE USED IN THE FOLLOWING g p arty y
STATE: understand they may be liable for payment of all taxes Po :5 1` Oli.i t d i n
(REQUIRED) due on the purchase price for the goods as allowed by Charge 0.00
(Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed In Ca „1 );.ic k
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED)
Uy4.r rit_ki,o leds3 the receirt of a coillple
Resale Under penalty of perjury, signee swears th! i
Government information on this statement is true and correct in Cory of this iale5 st..r and the Purchase a
Exempt organization every material manner. A willfully false representation
Agricultural Production of exemption will cause the purchaser to be subject to the described iierzhardile t shall be sr
Dairy Production penalty and /or other provisions as allowed under state atLolld`rnce with the Cardholder ttsreerierl
Livestock Production
Floriculture /Aquaculture Production law'
Other: Si3nahire:
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 8�g�� #CBtEaS838xsSSG ESS &dR8k1�
E] Fe rtilizer/Ag rich emical s nt33t: i< s�> 388�r ,SdBraY3�.�r�83t>i�Sod•.:t83x
Consumed in Production (KS) Resale (Sales Tax Permit
Call 800 -x+68 -0731 within i' drys Eo
Ingredient or Component Parts (KS) c,urar iete a survey and be e i tered is a
Ir�ont•hl.y drawins ior� a chance tt, tnn a
F Other: $2500 ahoi s+ °rep.,
(AI -girded as Gif i Card" NO PURCHAS
CUS SIG E MGR. APPROVAL
r X
t "SHA DED AREA ONLY
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
ITIEM NUMBER DESCRIPTION UNIT PRICE
Farm No. 99.00401 (12/05) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS TO:
ErINKT011 TRACTOR SUPPLY COMPANY
lowfifty
P.O. Box 9020 rrac.ur supply ❑uirw wwy
VZOU Des Moines, IA 50368-9020 19160 U.S. 31 North
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wes ,IN 460(4
(6035 301
NAME -'ii! 4,T1001Wi2 2 903370
01/1-W 09;3 am
ADDRESS ss 5F'ECfAl- ORDER CONFRACT ttt
SF Order 1.: 431052091
CITY STATE ZIP PHONE C•RMEI. 5'rREEr DEP'l'
31100 IJ 13151 SaT
WESIFIELD IN 460748267
CUSTOMER TO COMPLETE (317) 371-21-10
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- 0222220 CHORE B11315
The undersigned certifies The undersigned party certifies their exemption from 1, 00 75 00 175 00
compliance with the agricultural payment of sales and use tax on tangible personal 8601004 6170 rVEIGH
sales tax exemption law of the state property as indicated below and/or purchaser is 1.00 L) 5.00 5.00
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 stk" tol'al
Exemption Statement at right and resale and/or uses the farm machinery, equipment or 7100,11 Tax 5,60
the applicable statement o the other agricultural production items purchased free of i0tal 813.60
respective state printed on the Dei t Br
tax, as defined by state law, and as indicated below.
reverse side of this form. TSC CRI d
PRODUCTISTO BE USED INTKE FOLLOWING The undersigned party further certifies they Ai-ri:1:-12�aVtlt**116096
STATE: understand they may be liable for payment of all taxes At, tit 0"102Z6 !'�ef t: 2008331622
PO WOLIPtWIP
(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 0. oij
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws.
PURCHASER IS ENGAGED IN: (REQUIRED)
F-1 Resale Under penalty of perjury, signee swears the BALANCE DUE; 0.00
Government information on this statement is true and correct in Buyer acknboledse-, the receirl of a Co,
Exempt organization fed
E] Agricultural Production every material manner. A willfully false representation upy ti; this 5alQ�' -,Ij.p and the Purcha-5e o
E) Dairy Production of exemption will cause the purchaser to be subject to c
penalty and/or other provisions as allowed under state
E] Livestock Production tho described .,ierchandise shall 'Lie is
Floricullure/Aquaculture Production law. accordancQ with the Cordholder Asreeii,ent
Other: I
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery /Repair Parts Government Agency (Entity t
Livestock Iniestibles or Injeclibles Exempt Organization (Entity
F Fertflizer/Agrichernicals NC. only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit
Ingredient or Component Parts (KS)
F1 Other: Call DOO-968 0735 within 7 days to
carni-lete u -,,rvey and be enterud iti a
i,iunthl� dr .-wins fur a C;Iance to win a
CUSTO SIGN MGR. APPROVAL �2506 t5hovon3 1 .1fCCO,
(Awarded as Gift Card) NO PURC+lASF
7 �IUSE.SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE.
CASH VISA r- DISCOVER I TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
ITEM NUMBER DESCRIPTION UNIT PRICE
Form No, 99-00401 (12105) 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))
02/25/09 $531.89
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Tractor Supply
IN SUM OF
P. O. Box 9020
Des Moines, IA 50368 -9020
$531.89
.ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
2201 43- 560.01 $531.89 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
J
F i ay, uary 27, 2009
a
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund