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168720 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 t4� ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $595.30 ra CARMEL, INDIANA 46032 PO Box 689020 a DES MOINES IA 50368 -9020 CHECK NUMBER: 168720 CHECK DATE: 2/4/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUM BER AMOUNT DESCRIPTION 2201 4237000 0860 282.33 6035301200050860 2201 4356001 0860 312.97 6035301200050860 I Operatzom Center 2/3/2009 10:05 AM PAGE 2/002 Fax Server s CHARGED BY: MAIL PAYMENTS TO: STEVE JONES TRACTOR SUPPLY 3400 W 131ST ST P.O.BOX 689020 3400 W 131ST ST DES MOINES IA 50368 -9020 WESTFIELD IN 46074 -8267 MAKE CHECKS PAYABLE TO: TRACTOR SUPPLY PLEASE INCLUDE ACCOUNT NUMBER ON CHECK TO ENSURE PROPER PROCESSING ACCOUNT NO *5866 P.O. NO STEVEJONES INVOICE NO 624001063191010 INVOICE DATE 12/15/08 INVOICE AMT 107.98 CHARGED AMT 107.98 AMOUNT YOU PAY DESCRIPTION S.K.U. QUANTITY PRICE EXTENSION JKT SHERPA DCK HD XL 7141310 1.00 53.99 53.99 JET SHERPA DCK HD XL 7141310 1.00 53.99 53.99 SUBTOTAL: 10'1.99 TAX: 0.00 SHIPPING: 0.00 INVOICE TOTAL: 10 DIRECT INQUIRIES TO SERVICE REP: 1 -B00- 559- -8232 FAX: page 1 of 4 Tx 7 01730 TOR° =Z2 ®SUPP y BUSINESS ACCOUNT 1 0000303 F 9 F 'f R$ AGG(?UIdT SUMMARY Q35 30i 2� OQ05 486Q 3 x j 11 a b:.zk. _.n a• s a_ �a a a• a Previous Balance 1,274.90 Closing Date 01/20/09 Payments 0.00 Next Closing Date 02/18/09 CARMEL STREET DEPT Credits 0.00 Payment Due Date 02/14/09 CINDY Purchases 487.31 3400 W 131 ST ST Debits 0.00 Current Due 487.31 WESTFIELD, IN 46074 -8267 FINANCE CHARGES 0.00 Past Due Amount 1,274.90 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 1,762.21 Credit Available 3,287 New Balance 1,762.21 CURRENT ACTIVITY �a ,�s. R ..a...x vs»,, x'•�,''s c ��ra•Y?�; k" �g.... u� =sv� _'�:3. m.�... .v: rc�., �'s a �s o JAN 5 GOODS AND SERVICES WESTFIELD IN 79.99 TOTAL 6035301200074811 $79.99 DEC 19 GOODS AND SERVICES WESTFIELD IN 6.29 DEC 29 GOODS AND SERVICES WESTFIELD IN 84.54 JAN 6 GOODS AND SERVICES WESTFIELD IN 7.78 JAN 13 GOODS AND SERVICES WESTFIELD IN 183.72 TOTAL 6035301202895973 $282.33 JAN 5 GOODS AND SERVICES NOBLESVILLE IN 124.99 TOTAL 6035301202896013 $124.99 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 Wlug PERCENTAGE Finance Charge Rate P. RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 33 0.00 0.00 .00000 29 0.00 31 aka, 63 5uo,0; 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) for cash advances. if your account is subject to a daily periodic rate we figure Grace Period on Purchases. You can avoid periodic finance charges on purchases, but not on cash advances. This is called a grace period on the periodic finance charge by T 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 subject 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 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 due 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 on 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 finance c and by the applicable daily periodic rate. separately for each balance. Balances include regular purchases, regular cash promotional balances. The result u the periodic finance chargges for that balance. For each purchase advances, and different p 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 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 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 billing 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 Subj to Finance Charge Calculation Method. If the o The dollar amount of the suspected error. front o you 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 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 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 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. o 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: 4740 121st 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 yyour 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. 07/0 soon as the day we receive the check. Also, the check will be destroyed. 603TV5740708-Cit page 2 of 4 TX 7 Ofi70 w rRACM SUPPLY c- BUSINESS ACCOUNT �.0 0000304 �o t CURRENT ACTIVITY frans�ction Qcati611� sky Amount Did you overlook your payment to us? If so, please send the amount due today. If payment is in the mail thank you! This account is subject to the Alternate Balance Subject to Finance Charge Calculation Method. See back for details. Remit To: Bill To: Page 3 or 4 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 T= DEPT.30 1200050860 GARY JONES SU"LYC2 PO BOX 689020 i 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000505 Payment Due Date: 02/14/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN eon SHIP TO: INVOICE: SHIP To:' INVOICE: 431000900390010 431000896098010 Purchase Order: Purchase Order: WINTERCOAT 121908 AMOUNT DUE: 79.99 AMOUNT DUE: 6.29 Store: 574000451 INVOICE DATE: 01/05/09 Store: 574000431 INVOICE DATE: 12/19 /08 COAT SNOSTN XL CHOC CT 7154567 1.00 79.99 79.99 QUICK COUPLER 2IN PART 2121666 1.00 6.29 6.29 SUBTOTAL 79.99 SUBTOTAL 6.29 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 79.99 TOTAL 6.29 SHIP To: INVOICE: SHIP TO: INVOICE: 431000899159010 431000900667010 Purchase Order: Purchase Order: 122908 10609 AMOUNT DUE: 84.54 AMOUNT DUE: 7.78 Store: 574000431 INVOICE DATE: 12129 /08 Store: 574000451 INVOICE DATE: 01/06 /09 QUICK COUPLER 21H PART 2121674 1100 11.99 11.99 NIPPLE KALE TPT 2 2110681 1.00 2.99 2.99 ANGLE BALL VALVE 2 BOLT 2107581 1.00 35.99 35.99 BLANK BRASS PLUG 2101250 1.00 4.79 4.79 QUICK COUPLER 2IN PART 2121682 1.00 6.29 6.29 QUICK COUPLER 2IN PART 2121674 1.00 11.99 11.99 SUBTOTAL 7.78 QUICK COUPLER 2IN PART 2121674 1.00 11.99 11.99 TAX 0.00 QUICK COUPLER 2IN PART 2121682 1.00 6.29 6.29 SHIPPING 0.00 SUBTOTAL 04.54 TOTAL 7.78 TAX 0.00 SHIPPING 0.00 TOTAL 84.54 Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 I Remit To: Bill To: Page 4 or 4 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 PJS�TV DEPT.30- 1200050860 BRAD HENDERSON .7 V PO BOX 689020 3400 W 131ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000306 ME Payment Due Date: 02/14/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN sHIP To: INVOICE: SHIP To: INVOICE: 4310009020551010 624001074070010 Purchase Order: Purchase Order: 11309 10509 AMOUNT DUE: 183.72 AMOUNT DUE: 124.99 Store: 574000431 INVOICE DATE: 01/13 109 Store: 574000624 INVOICE DATE: 01/05/09 QUICK COUPLER 2IN PART 2121674 1.00 11.99 11.99 BOOT LTHR STOE ISM TL67 7342673 1.00 124.99 124.99 QUICK COUPLER 21M OUST 2121705 1.00 10.99 10.99 QUICK COUPLER 21N PART 2121640 1.00 11.99 11.99 SUBTOTAL 124.99 QUICK COUPLER 2IN PART 2121674 1.00 11.99 11.99 TAX 0.00 QUICK COUPLER 2IN PART 2121666 1.00 6129 6.29 SHIPPING 0.00 BOLTED BALL VALVE 21N F 2100741 1.00 27.99 27.99 PUMP 12V 3.8GPM QUAD 2102222 1.00 99.99 99.99 TOTAL 124.99 CAP 1 /41N GALV 3149227 1.00 2.49 2.49 SUBTOTAL 183.72 TAX 0.00 SHIPPING 0.00 TOTAL 183'.72 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 REMIT TSC BUSINESS ACCOUNT iF TWTOR PAYMENTS TO: TRACTOR SUPPLY COMPANY SU"LYCOM P.O. Box 9020 Tractor t'Sural Company Des Moines, IA 50368 -9020 19160 U.C. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wes t f ie ld, TN460 ?4 6035 301# (317) b67 NAME CARMEL S'I Rt =E1' DEPT 3400 W 131ST ST UISTFIELD 111 4150748267 ADDRESS (3117 571-2141 CITY STATE ZIP PHONE 431 43 10001 79 2 90066(' 011061200Y 03 01 er,: CUSTOMER TO COMPLETE ?1106,1 NIPPLt-. MALE TPI 2 1.00 t 2 ,1 ?9 7.97 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Goverritroent Asencies The undersigned certifies The undersigned party certifies their exemption from `l 012 'j0 BLANK BRASS PLUG compliance with the agricultural payment of sales and use tax on tangible personal 1.00 4.79 4.79 NT sales tax exemption law of the state property as indicated below and /or purchaser is Goverttlrient i)sencies indicated below and understands engaged in the business of agricultural production of and agrees with the General Subtotal 7.78 food or fiber, horticulture, aquaculture of floriculture for 7,00% Tax Exemption Statement at right and resale and /or uses the farm machinery, equipment or 0,00 the applicable statement of the Total 7.78 respective state printed on the other agricultural production items purchased free of TSC Card 7.76; reverse side of this form. tax, as defined by state law, and as indicated below: PRODUCT tSTOBE USED IN THE FOLLOWING The undersigned party further certifies they Al.t th 006054 Re I` 0: 061 W 13468 i:.8 ;17;010609 srarE: understand they may be liable for payment of all taxes K 0 Chan (REQUIRED) due on the purchase price for the goods as allowed by 0.40 (Exceptions: Georgia, New York Kentucky State law ShOUId SUCK gOOds be USed Or consu in La511 Bac COMPLETE REVERSE SIDE) PURCHASER IS ENGAGED IN: (REQUIRED) a taxable manner as defined by state laws. Buyer the receiet of a curlrle Resale Under penalty of perjury, signee swears the cot Y. of this 5- slip and t'i'le Purchase o Government information on this statement is true and correct i n Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to the +ir5cr:iUed Itterchindi5e shall be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreelnent Livestock Production law. Floriculture /Aquaculture Production Other: snatur e ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) _.m______. W._________._ Farm Machinery/Repair Parts Government Agency (Entity _Livestock Injestibfes or Injectibles Exempt Organization (Entity NC: only DOT and US Government are exempt F1 Fertilize r(Agrichemicals rd983s3��9tt :3S #73, #u8$S #3P #8 #x Consumed in Production (KS) Resale (Sales Tax Permit Ca 11 800 -969 -0734 wi thin 7 days to Ingredient or Component Parts (KS) catae l,:'te a 5uvvr y and be entered in a alcnthly drawin-; for a chance to win a F1 other: 72500 ShoPPins 5rree. (Awarded t,5 Gif Card) NO PURCHASE CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL Zj X IN USE SHADED AREA ONLY WHEN REGISTER IS CASH CHECK, VISA "M /C DISCOVER TSC CHARGE ACCOUNT NO. CHU. EXCH. DATE L) r ITEM NUMBER DIESCRIPTIO Form No. 99 00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 17TRACT01t PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPRY CO P.O. Box 9020 Tractor 3 C No rth Des Moines, IA 50368 -9020 18160 U.S. U,s. 31 ND,•th TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Uestf ield, IN 46074 6035 301 317) 967 NAME CARMEL STREET DEFT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 131 623000089 2 902051 01/13/2009 09 CUSTOMER TO COMPLETE 2171674 OUICK COUPLER 210 PA 1.00 ii,99 11.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT Geverr,r.Ient Asencie5 The undersigned certifies The undersigned party certifies their exemption from 2121705 QUICK COUPLLR 2IN DL' compliance with the agricultural payment of sales and use tax on tangible personal 1.00 10,99 10,99 NT sales tax exemption law of the state property as indicated below and /or purchaser is Guverntaent Asenc.ies 2 indicated below and understands engaged in the business of agricultural production of 121640 QUICK COUPLER 2IN PA and agrees with the General 1 00 L 11 99 11 .99 NT Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for r resale and /or uses the farm machinery, equipment or .,overr,!ient A _-encie5 the applicable statement of the other agricultural production items purchased free of 2121674 Q UICK COUPLER 2IN PA respective state printed on the tax, as defined by state law, and as indicated below. 1 00 L 11 99 11 99 NT reverse side of this form. Government Asencie= PRODUCTISTOBEELISE /QINTHEFOLLOWING The undersigned party further certifies they 2111666 QUICK COUPLER 2IN PA STATE: ..1�' understand they may be liable for payment of all taxes 1 00 C' 6, 6 29 i': (REQUIRED) due on the purchase price for the goods as allowed by Government A5enc.i.e5 (Exceptions: Georgia, New York 8 Kentucky state law Should such goods be used or Consumed In 21007 BOLTED BALL VALVE 21 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 1.00 2 7 99 2r. NT PURCHASER IS ENGAGED IN: (REQUIRED) LOv�raoent Agencies 21 02222 F'U�1F' 1 2•;r 3 r�Gl -'t1 Q11rID ❑,►r esale Under penalty of perjury, signee swears the 1 00 y9,o9 99,99 NI Government information on this statement is true and correct in Exempt organization every material manner. Awillfully false representation Government Asencae5 Agricultural Production of exemption will cause the purchaser to be subject to 31- 1922Y CAP 1/41M GALV Dairy Production penalty and /or other provisions as allowed under state 1.00 2.49 2,49 NT Livestock Production Govertment Asencies Floriculture /Aquaculture Production law. Other: Subtotal 183.72 7.00% Tax 0.00 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) T o t a 1 1 e2 Farm Machinery/Repair Parts Government Agency (Entity# TSC Card 183.77 Livestock Injestibles or Injectibles Exempt Organization (Entity OL u t 0: 14 S t t t Y 3 t t t a 59 i S Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Au t ht' 013152 Ref tr ;1308532.099 Cons med in Production (KS) Resale (Sales Tax Permit 0 9 01 I dU Chanse 0.UO I redient or Component Parts (KS) Cash Bac Other: Buy acknowledses the receipt of a couplc tee i CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL copy of this sale: slip and the vurchase o f X the Described merchandise shall be in CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L] DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINES ACCOUNT T PAYMENTS TO: TRACTOR SUPPLY COMPANY SU"'LYC� P.O. Sox 9020 Des Moines IA 50368 -9020 Tra S ,S1 Nor TSC TEAM MEMBER TO COMPLETE t 8160 e d 3 607 th Please include 16 Digit Account Number We�tf field, It7. 46474 6035 301# (:317) 867 3545 NAME CARiIEL STREET DEFT 3400 0 131ST ST ADDRESS UESTFIELD IN 460748267 317) 5'71 2141 CITY STATE ZIP PHONE 431 431000172 1 900390 01/05/2009 10r14an CUSTOMER TO COMPLETE 1 7134567 COAT SNDS N XL CHOC CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1.00 1? 79.99 75 .99 NT Res. F'rice: 99.99 The undersigned certifies The undersigned party certifies their exemption from Government A -3encie5 compliance with the agricultural payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is Subtotal 79.99 indicated below and understands engaged in the business of agricultural production of 7,002 Tax 0100 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 'Fatal 79.99 Exemption Statement at right and resale and /or uses the farm machinery, equipment or TSC Card 79,99 the applicable statement of the other agricultural production items purchased free of Acct* t z s #4811 respective state printed on the tax, as defined by state law, and as indicated below. ALI tht: 005362 Ref#:050914325A reverse side of this form. Pa winter coat PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Chanse 0,00 STATE: understand they may be liable for payment of all taxes Cash Back (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 Buyer acknouledses the receipt Of a comple COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. to d PURCHASER IS ENGAGED IN: (REQUIRED) copy of this sales slip and the purchase O E Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in the described merchandise Shall 6e in Exempt organization every material manner. A willfully false representation accordance with the Cardholder Asreeclent. 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 /AcluacultureProduction law. �ai3sa2tL,�Y'P: Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity# Livestock Injestibles or Injectibles Exempt Organization (Entity Fertilizer /Ag rich emicals INC: only DOT and US Government are exempt fall 800- 968 -0734 within 7 days to D Consumed in Production (KS) Resale (Sales Tax Permit cowip letr_ a survey and be en tered in a monthly drawing for a chance to win a Ingredient or Component Parts (KS) $2500 shrol }ping Spree. Other: (Awarded as Gift Card) NO F'URCHASE GIS SURVEY NECESSARY. Ends 9/30/09, CUSTOMER SIGNATURE: (REQUIRED) MGR, APPROVAL X X' USE SHADED AREA ONLY WHEN REGISTER IS IN CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE P ITEM NUMBER DESCRIPTIO Form No. 99.00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SUI%y flo P.O. Box 9020 Des Moines, IA 50368 -9020 Tr «c for SurrIY Comp al„ 18160 U'S' 31 Nortil TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West1' ield. IN' 46074 6035301 317) 867 -3505 NAME CARMEL STREET DEP-1 3400 W 131ST 5T ADDRESS WESTFIELD 1N 460740267 (317) 571 -2141 CITY STATE ZIP PHONE 431 431000179 2 899159 12/29/2008 03:20Pnl CUSTOMER TO COMPLETE 2121674 QUICK COUPLET: 21N PA CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- 1 .00 t? 11.99 11.99 NT Government Agencies The undersigned certifies The undersigned party certifies their exemption from 2107581 ANGLE BALL VALVE 2 3 compliance with the agricultural payment of sales and use tax on tangible personal 1 00 35,99 35.99 NT sales tax exemption law of the state property as indicated below and /or purchaser is Government regencies indicated below and understands engaged in the business of agricultural production of 2121682 NICK COUPLER 2IN PA and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 1100 6,29 6 29 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 2121674 (QUICK COUPLER 21N PA respective state printed on the tax, as defined by state law, and as indicated below. 1.00 0 11 99 11 99 NT reverse side of this form. Government Agencies PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 212167-; QUICK COUPLER 21N STATE: understand they may be liable for payment of all taxes 1.00 R 11 99 11.99 h (REQUIRED) due on the purchase price for the goods as allowed by Government Agencies Georgia, New York Kentucky 2 (Exceptions: 9 y state law should such goods be used or consumed in iZlbli2 QUICK COUPLE(. 21N PA COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. 1.00 N 6'2S 6.29 NT PURCHASER IS ENGAGED IN: (REQUIRED) Government Atiencie5 Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in Subtotal 84.54 Exempt organization every material manner. A willfully false representation 7.00% lax 0100 Agricultural Production of exemption will cause the purchaser to be subject to T tal 01.54 Dairy Production penalty and /or other provisions as allowed under state TSC Card 84.54 Livestock Production Floriculture /Aquaculture Production law. Acc t4 t t t i t t t t t t t t 5973 ALI th0: 029672 Reff-:2914284348 Other. PO t 122 "08 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Ci a n ge 0.00 Farm Machinery/Repair Parts Government Agency (Entity Ca 3h Back Livestock lnjestiblesorinjectibles Exempt Organization (Entity Buyer acknowledges the receipt of a comele Fertilizer /Agrichemicals NC: only DOT and US Government are exempt t e J Consumed-in Production (KS) Resale (Sales Tax Permit# e copy of this sales 511h and the Purchase o Ingredient or Component Parts (KS) the described merchandise ,hall be in Other: accordance with the Cardholder Agreement, CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL S i!j n a t u r e: 2 2 Y I x USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE Li ITEM NUMBER DESCRIPTION Form No. 99 -00401 (1 ?/05) CUSTOMER ORIGINAL REMIT TSC two!I ES5 Ai:WILINT TRACTOR SUPPLY COMPANY '"09MYCQ P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 2375 East P leasant St, TSC TEAM MEMBER TO COMPLETE Please include 16-Digit Account Number Noblesvil IN 46060 6035 301 317) 776 -1883 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 624 624000070 1 1074070 01/05/2009 02 :16rm CUSTOMER TO COMPLETE 7342673 BOOT LTHR STOE 13M T 1.00 124.99 124.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT Government Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 124.99 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00% Tax 0.00 indicated below and understands engaged in the business of agricultural production of Total 124.99 and agrees with -the General TSC Card 124,99 food or fiber, horticulture, aquaculture of floriculture for Exemption Stateme at right and Ac c t t; i s; i E E t i i 6013 resale and /or uses the farm machinery, equipment or the applicable stat ment of the other agricultural production items purchased free of AI.Ith�:005956 Ref *;0513163008 respective state p nted on the tax, as defined by state law, and as indicated below. PO 0 :010509 reverse side of this f rm. Chanse 0100 PRODUCT IST u 1 THE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes Buyer acknowledse5 the receipt of a conlple I ED) due on the purchase price for the goods as allowed by (Exceptions: Geor New Y ork a Ke ntucky state law should such goods be used or consumed irk d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. COPY of this sales slip and the Purchase o PURCHASER IS ENGAGED IN: (REQUIRED) f Resale Under penalty of perjury, signee swears the the described merchandise shall be in Government information on this statement is true and correct in accordance with the Cardholder Asreement, Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other provisions as allowed under state Sisnature: Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Call 800 0734 within 7 days to 1 1 Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt comp a survey and be entered in a Resale (Sales Tax Permit# monthly drawins for a chance to win a F1 Consumed in Production (KS) $2500 5hOPpins spree Ingredient orC mp e' P S s) (Awarded as Gift Card) NO PURCHASE /�j OR SURVEY NECESSARY, Ends 9130109. Other: 2;## #i #EYEiiiEE ##i ;i #iitEi##tEiii# CUSTOMER SIGNATURE:(RF UIREr'; MGR. APPROVAL X USE SHADED 'AREA INOP ERATIVE. CASH CHECK VIS M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L] L] ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT T PAYMENTS TO: IF TRACTOR SUPPLY COMPANY LI� Yco P.O. Box 9020 Eractoi- Supriv Cotarane Des Moines, IA 50368 -9020 11D60 U.S, 31 Nor TSC TEAM.MEMBER TO COMPLETE Please include 16 Digit Account Number WesTJ icird, TAE 460'4 6035 301# (31 7) 867-3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS W S1 YW 46074826 (31.i') 571 -2.141 CITY STATE ZIP PHONE 431 766000104 2 9960vs 12,11Y/2008 09: 04altl CUSTOMER TO COMPLETE 2121666 QUICK COUP 21N PA 1.00 e 6.29 6.19 N1 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: E_overnarettt A5enciel- The undersigned certifies The undersigned parry certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal st.16iota). 6.29 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00% T ax 0100 engaged in the business of agricultural production of indicated below and understands Total 6.29 and agrees with the General TSC Card 6. Z? food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and flcc.te: #as #E #15973 resale and/or uses the farm machinery, equipment or the applicable statement of the other agricultural production items purchased free of Authtk:01973?0 Re- tW908034747 respective state printed on the tax, as defined by state law, and as indicated below. P10 #1111906 reverse side of this form. Chan;e 0100 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes BLtrer ac knowletlse5 tale t er Eir t of a r.crre (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 Irl f COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. r.or Y Of flhiS 511e5 Slit` iADd the PUrCth15C G PURCHASER IS ENGAGED IN: (REQUIRED) 4 Resale Under penalty of perjury, signee swears the the desrrib d IaerLtandise shall t;1 ill Government information on this statement is true and correct in accordance. with he Cardnntder 6reealent, E=xempt 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 Sisnrtture Livestock Production F Floriculture /Acivaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery /Repair Parts Government Agency (Entity Livestock lnjestibles or lnjectibles Exempt Organization (Entity# Call 800 ?U'S 07, i f within I day, to Fertilizer /Agrichemicals INC: only DOT and US Government are exempt CUPWlete a 501'VeY and be entered ill a IaQil thlY drawing for a chance t0 win d Consumed in Production (KS) Resale (Sales Tax Permit $7500 shop p ins Ingredient or Component Parts (KS) (Awarded a5 Gift Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9 30109. Other: CUSTOMER SIGNATURE: (REQUIRED) I MGR. APPROVAL i 2 Y4_ X USE SHADED AREA ONLY CASH CHECK VISA M/C 'DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (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)) 01/27/08 $204.98 01/27/08 $282.33 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer VOUCHER N WAR NO. ALLOWED 20 Tractor Supply IN SUM OF P. O.. Box 9020 Des Moines, IA 50368 -9020 $487.31 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 43- 560.01 $204.98 1 hereby certify that the attached invoice(s), or 2201 42- 370.00 $282.33 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 hursday, /Jan fared ?29, 2009 Street Commissioner tio fitle mr„+ss ener Cost distribution ledger classification if claim paid motor vehicle highway fund