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HomeMy WebLinkAbout167707 01/07/2009 ,a CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO +o CARMEL, INDIANA 46032 PO Box 689020 CHECK AMOUNT: $1,240.11 DES MOINES IA 50368 -9020 CHECK NUMBER: 167707 CHECK DATE: 1/7/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4356001 84.99 6035301200050860 2201 R4356001 18753 1,155.12 6035301200050860 page 1 of 7 Tx 7 D 130906000 �Si1PPI.YCf 0000504USiNESS ACCOUNT AGC©UNTSliMItRARY' 60353Q1!2 0045 080 �er�,. x .,w=. d4 a. t. Previous Balance 2,697.34 Closing Date 12/18/08 Payments 2,776.10 Next Closing Date 01/20/09 CARMEL STREET DEPT Credits 199.93 Payment Due Date 01/12/09 CINDY Purchases 1,553.59 3400 W 131 ST ST Debits 0.00 Current Due 1 ,274.90 WESTFIELD,IN 46074.8267 FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 1,274.90 Credit Available 3,975 New Balance 1,274.90 CURRENT ACTIVITY TrarlSaa sLOGatIotV 3 g� ,s a' -iY NOV 26 GOODS AND SERVICES NOBLESVILLE IN 84.99 TOTAL 6035301200074753 $84.99 i NOV 20 GOODS AND SERVICES NOBLESVILLE IN 409.80 NOV 26 GOODS AND SERVICES NOBLESVILLE IN 50.97 DEC 12 GOODS AND SERVICES NOBLESVILLE IN 84.99 TOTAL 6035301200074795 $545.76 DEC 8 GOODS AND SERVICES WESTFIELD IN 84.99 TOTAL 6035301200074829 $84.99 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Dally Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Billing PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0100 .00000 29 0.00 0.0o 00000 29 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 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 riot 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 dais Interest or 0 11 /o balances that do expire by the Next Closing Date shown on the balances for the billing period and divide by the number of clays 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 Certain promotional offers may take the period purchases. previous billing period if your account was credited for the full New Balance, P Y away grace P on p plus the minimum monthly payments required for your No Interest and Olo 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 separately for each balance. Balances include regular purchases, regular cash number It days in the billing period and by the applicable daily each p periodic rate. advances, and different promotional balances. The result is the periodic finance charges for that balance. For each purchase balance, multiply the Balance Subject to Finance Charge for the current billing To get a dally balance. sve 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 or day. %1Ie 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, founding 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 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 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. Your name and account number. Alternate Balance Subject to Finance Charge Calculation Method. If the 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 fee to the regular revolve credit plan balance. We processingg 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 payment we receive that is not in proper form or is not sent to the correct Pay Phone Service. You may use this service any time make a address. The correct address for a payment sent by regular mail is the address payment .m. E a nt asterr phone. You will charged to use f service. vice. Call by 5 listed on the return envelope or on the front of the payment coupon. A after En memo to have your payment credited as of that day. If you call a payment made in -store is not sent to the correct address. The correct address after that time, your payment will be credited as of the next day. We may for a payment sent by courier or express mail is the Express Payments process your payment electronically after we verify your identity. 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 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 Cl2C 5603TV Rev. 07/ 08 soon as the day we receive the check. Also, the check will be destroyed. 603TV5740708 -Cit page 2 of 7 TX 7 D 1 -o WSU i 00 YYV02 Q BUSINESS ACCOUNT 0000505 CURRENT ACTIVITY Transaction s �g NOV 19 GOODS AND SERVICES WESTFIELD IN 199.96 NOV 25 GOODS AND SERVICES WESTFIELD IN CREDIT 99.98 TOTAL 6035301200074837 $99.98 NOV 20 GOODS AND SERVICES WESTFIELD IN .99 DEC 15 GOODS AND SERVICES NOBLESVILLE IN 107.98 TOTAL 6035301202895866 $108.97 DEC 9 GOODS AND SERVICES WESTFIELD IN 74.99 TOTAL 6035301202895882 $74.99 NOV 20 GOODS AND SERVICES WESTFIELD IN 76.96 TOTAL 6035301202895924 $76.96 DEC 1 GOODS AND SERVICES WESTFIELD IN 85.07 DEC 2 GOODS AND SERVICES WESTFIELD IN 7.99 TOTAL 6035301202895932 $93.06 NOV 26 GOODS AND SERVICES NOBLESVILLE IN 99.95 TOTAL 6035301202896104 $99.95 NOV 24 GOODS AND SERVICES WESTFIELD IN 99.96 TOTAL 6035301202896112 $99.96 DEC 8 GOODS AND SERVICES WESTFIELD IN 84.00 TOTAL 6035301202896138 $84.00 NOV 24 GOODS AND SERVICES NOBLESVILLE I CREDIT 99.95 TOTAL 6035301202896146 599.95 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS NOV 21 PAYMENT REF P91940ONN09E4TLOW 834.82 DEC 18 PAYMENT REF P91940OPH09DKYMB5 1,941.28 Customer Service and Billing Errors address: PO Box 653029, Dallas, Tx 75265 -3029. CARD AGREEMENT INFORMATION UPDATE. PLEASE KEEP THIS NOTICE. We are adding an optional Pay by Phone Service. This service is disclosed in the following new section which we are adding to your Card Agreement: "Optional Pay by Phone Service. You may request to make your payment by phone using our optional Pay by Phone Service. Each time you make such a request, you agree to pay the amount shown in the Pay by Phone section on the back of the billing statement. Our representatives are trained to tell you this amount if you decide to use this optional Pay by Phone Service." This account is subject to the Alternate Balance Subject to Finance Charge Calculation Method. See back for details. Remit To: Bill To: Page 4 or 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TR' DEPT.30 1200050860 RON WILLIAMS 10SUff"Lx� PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000507 Payment Due Date: 01/12/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN o� SHIP TO: INVOICE: SHIP TO: INVOICE: 624001061554010 431000893271010 Purchase Order: Purchase Order: VERBAL 120808 AMOUNT DUE: 84.99 AMOUNT DUE: 84.99 Story. 574000624 INVOICE DATE: 12/12 /08 Store: 57 4 0 0 0431 INVOICE DATE: 12108 /08 BOOT 12IN ISM WELLINGTO 6430724 1.00 64.99 84.99 BIB SNDSTN LN 44X30 BN 7047956 1.00 84.99 a4. 99 SUBTOTAL 84.99 SUBTOTAL 84.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0100 TOTAL 84.99 TOTAL 84.99 V SHIP TO: INVOICE: SHIP TO. INVOICE: 431000888303010 431000889934010 Purchase Order: ERIC AMOUNT DUE: 199.96 AMOUNT DUE: 99.98 Store: 574000431 INVOICE DATE: 11/19 /08 Store: 574000431 INVOICE DATE: 11125 /08 SPECIAL ORDER PAYMENT 431052047 1.00 199.96 199.96 SPECIAL ORDER ARTICLE 0222220 1.00 99.98 99.96 SUBTOTAL 199.96 SUBTOTAL 99.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SNIPPING 0.00 TOTAL 199 -96 TOTAL 99.98- Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801- 779 -7425 LI Remit To: Bill To: Page s of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TRACTOR DEPT.30- 1200050860 JASON FORCE ®Suff"WCO2 PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000509 Payment Due Date: 01/12/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TD: INVOICE: SHIP TD: INVOICE: 4431000891309010 431000891585010 Purchase Order: Purchase Order: PARKS 120208 AMOUNT DUE: 85.07 AMOUNT DUE: 7.99 Store: 574000431 INVOICE DATE: 12/01 /08 Store: S740DD431 INVOICE DATE: 12/02 /08 SPECIAL ORDER PAYMENT 431052050 1.00 85.07 85.07 SUSPENDERS BU 5001679 1.00 7.99 7 -99 SUBTOTAL 85.07 SUBTOTAL 7.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 85.07 TOTAL 7.99 J SHIP TO: INVOICE: SHIP TO: INVOICE: 624001053621010 431000889681010 Purchase Order: Purchase Order: 112608 112408 AMOUNT DUE: 99,95 AMOUNT DUE: 99.96 Stara: 574000624 INVOICE DATE: 11126 /08 Store: 574000431 INVOICE DATE: 11124 108 BOOT NETL MUCK 10 BR SN 7152002 1.00 99.95 99.95 JKT ARCTIC BLK 42T 6420397 1.00 99.96 99.96 SUBTOTAL 99.95 SUBTOTAL 99.96 TAX 0.00 TAX D.DO SHIPPING 0.00 SHIPPING 0.00 TOTAL 99.95 TOTAL 99.96 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425 ,f Remit To: Bill To: Page 3 of 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860C DEPT.30 1200050860 JIM HOBBS 1ps,umYco- PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000506 Payment Due Date: 01/12/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: Oee� 624001053619010 624001043857010 Purchase Order: Purchase Order: 112608 RON AMOUNT DUE: 84.99 AMOUNT DUE: 884.42 Store: 574000624 INVOICE DATE: 11/26 /08 Store: 574000624 INVOICE DATE: 11106 /08 SPECIAL ORDER PAYMENT 624052671 1.00 84,99 84.99 SWTSHIRT HOODED NV BST 7385532 25.00 19.19 479 -75 SWTSHIRT HOODED NV REGS 7385493 23.00 17.59 404 -57 SUBTOTAL 84.99 TAX 0.00 SUBTOTAL 884.32 SHIPPING 0.00 TAX 0 -00 SHIPPING 0,00 TOTAL 84.99 TOTAL 884.42 V SHIP TO: INVOICE: SHIP TD: INVOICE: 624001050460020 624001053415010 Purchase Order: Purchase Order: RON RON AMOUNT DUE: 409.80 AMOUNT DUE: 50.97 Store: 574000624 INVOICE DATE: 11/20 /08 Store: 574000624 INVOICE DATE: 11/26 /08 BOOT WETL MUCK 9 BR SN 7151991 1.00 99.95 99.95 SWTSHIRT HOODED NV REGS 7385493 1.00 16.99 16.99 BOOT WETL MUCK 11 BR SN 7152010 1.00 99.95 99.95 SWTSHIRT HOODED NV REGS 7385493 1..00 16.99 16.99 BOOT WETL MUCK 10 BR SN 7152002 1.00 99.95 99.95 SWTSHIRT HOODED NV REGS 7385493 1.00 16.99 16.99 SWTSHIRT HOODED NV REGS 7385493 5.00 21.99 1.09.95 BOOT WETL MUCK 9 BR SN 7151991 1.00 99.95 99.95 'BOOT-WETL-MUCK-10-BR SN- 7-152002- 1-.00 99.95 99.95 SUBTOTAL 409.80 TAX 0.00 SUBTOTAL 250.87 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 409.80 TOTAL 50.97 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: 60353012000508608 DEPT.30 1200050860 STEVE JONES IVSUMYCO- =o PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000508 Payment Due Date: 01/12/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000888625010 624001063191010 Purchase Order: Purchase Order: SHOP STEVEJONES AMOUNT DUE: 0.99 AMOUNT DUE: 107.98 Store: 574000431 INVOICE DATE: 11/20 108 Store: 574000624 INVOICE DATE: 12/15 /08 OR BOND SUPER GLUE 3487285 1.00 0.99 0.99 JKT SHERPA DCK HD XL OL 7141310 1.00 53.99 53.99 JKT SHERPA UCK HD XL OL 7141310 I.00 53.99 53.99 SUBTOTAL 0.99 TAX 0.00 SUBTOTAL 107.98 SHIPPING 0100 TAX 0.00 SHIPPING 0.00 TOTAL 0.99 TOTAL 107.98 I I `V SHIP T0: INVOICE: SHIP TO: INVOICE: 431000893542010 431000888499010 Purchase Order: Purchase Order: WINTERBOOTS PARKSPIFER AMOUNT DUE: 74.99 AMOUNT DUE: 76.96 Store: 574000431 INVOICE DATE: 12/09/08 Store: 514 0 0 0 4 31 INVOICE DATE: 11/20 /08 SHOE CHRE MID BK 11 SN6 7015080 1100 74.99 74.99 QUILT NEST JKT BLK XL 6420680 1.00 76.96 76.96 SUBTOTAL 74.99 SUBTOTAL 76.96 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 74.99 TOTAL 76.96 1 Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 1 Remit To: Bill To: Page 7 or 7 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 TRACTOR DEPT.30 1200050860 TRAVIS TABAK W Su"LYCe PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 54368 -9020 0000510 Payment Due Date: 01/12/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000893399010 431000886292010 Purchase Order: Purchase Order: TRAVIS WINTERGEAR AMOUNT DUE: 84.00 AMOUNT DUE: 84.99 Store: 574000451 INVOICE DATE: 12/08 /08 Store: 574000431 INVOICE DATE: 11/10/08 SPECIAL ORDER PAYMENT 4 ;1052065 1.00 84.00 84.00 BIB SNDSTN LN 36X32 BN 7048017 1.00 84.99 84.99 SUBTOTAL 84.00 SUBTOTAL 84 -99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 84.00 TOTAL 84.99 V SHIP TO: INVOICE: 624001052535010 AMOUNT DUE: 99.95 Store: 574000624 INVOICE DATE: 11124 108 BOOT NETL MUCK 9 BR SW 7151991 1.00 99.95 99.95 SUBTOTAL 99.95 TAX 0.00 SHIPPING- 0.00 TOTAL 99.95- Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 REMIT TSC BUSINESS ACCOUNT TI�I�CTOI�® PAYMENTS T TRACTOR SUPPLY COMPANY Invy"LYCo P.O. Box 9020 Tractor Supply COIilpanY Des Moines, IA 50368 -9020 2375 East P leasant St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesvil le, 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 1061554 12/12/2008 02:22pm CUSTOMER TO COMPLETE 6430724 BOOT 121N 13M WELLIN 1,00 84,99 84,99 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 84,99 sales tax exemption law of the state property as indicated below and /or purchaser is 7,00% Tax 0.00 indicated below and understands Total 84.99 engaged in the business of agricultural production of and agrees with the General TSC Card 84.99 food or fiber, horticulture, aquaculture of floriculture for Exemption Stateme t at right and Acc to i i i i; i i 4795 resale and /or uses the farm machinery, equipment or the applicable stat ment of the other agricultural production items purchased free of Auth #:01"2539 Refs:1 21 3221 238 respective state p nted on the PO :verbal reverse side oft f rm. tax, as defined by state law, and as indicated below. Chance 0,00 PRODUCT IS e u IN HE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Buyer acknowledses the receipt of a con,�"le (Exceptions: Geor New York a Ke ntucky state law should such goods be used or consumed inc d COMPLETE REVERSE SIDE) COPY of this sales slip and the Purchase O a taxable manner as defined by state laws. f PURCHASER IS ENGAGED IN:(REOUIRED) the described merchandise shall be in F] Resale Under penalty of perjury, signee swears the 0 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 /Acluaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR:(REOUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity# Call 800 -968 -0734 within 7 days to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a Resale (Sales Tax Permit monthly drawins for a chance to win a Consumed in Production (KS) 82500 shopp i ns spree. Ingre4orFom ent Pa (KS) (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9/30/09. ST MER EOUIR�� MGR. APPROVAL X USE SHA DEDAREA ONLY ASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L3 I ITEM NUMBER. DESCRIPTION UNIT PRICE Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY ou PPLYICO P.O. Box 9020 �1'ractUr Supply 1.0l;1I'a"nY Des Moines, IA 50368 -9020 1 U. 31 Nor TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West# field, IN 46074• 6035 301# (317) 367-3505 NAME CARhiEL STREET DEPT 3400 W 131ST ST ADDRESS WE STFl1: LD IN 460746267 (317) TeI -2 CITY STATE ZIP PHONE 431 ?8600w04 L i1gn, 12 /08/2008 1Q:07an1 CUSTOMER TO COMPLETE 7047956 DID SNDSTN LN 030 1.00 L 04.99 34.99 to t CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT, Gnvernment A5enr:ie5 The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal "'ubtotal 84,99 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 84,99 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TGC Card 84.99 Exemption Statement at right and resale and /or uses the farm machinery, equipment or )c c t Y Y Y Y $1 Y Y S E Y'S 4829 the applicable statement of the other agricultural production items purchased free of Auth *:008931 Ref f:080072002 respective state printed on the tax, as defined by state law, and as indicated below. PO 0:120808 reverse side of this form. Change 0,00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back STATE, understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Buyer acknowledges the receip 01 a roar le (Exceptions: Georgia, New York Kentucky state law Should such goods be used or consumed In= i COMPLETE REVERSE SIDE) COPY O't this 5dle5 51iP and the rurchase O a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) 'r 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 A5reemeot 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 Si Bna tore Livestock Production Floriculture /Aquaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) 43A# dYtttYtIYYY4YtYfYY2YYY3tYY6 •tYYYt Farm Machinery/Repair Parts Government Agency (Entity Livestock- Injestibles or Injectibles Exempt Organization (Entity Cal 800 -968 -0734 wi thin f drays to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt colnpleie a survey Etna be entered in 4; Consumed in Production (KS) Resale (Sales Tax Permit# monthly drawing for a chance to win a $2500 shopping spree. Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE Other: OR SURVEY NECE55ARY. Ends 9/30/09. �ccY�YxYYtxxs�t <sYtcYtteYYYY�R�astt�ss CUSTOMER IG U :(REQUIRED) MGR. APPROVAL i X USE SHADED AREA ONLY WHEN REGISTER IS IN CASH CHECK VISA M/C DISC ©VER TSG.CHARGE AG COUNT N0. CHO, EXCH. DATE ITEM NUMBER NO DESCRIPTIO TAX Form No. 99 -09401 (12105) CUSTOMER ORIGINAL �1� j��'1 REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: i.i ACTOR TRACTOR SUPPLY COMPANY SU YCQ P.O. Box 9020 I Tractor "uFFly Con any Des Moines, IA 50368 -9020 18160 U.S, 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number ic'- t ield iN 46074 6035 301# (31 867 -3505 NAME CARVE[. STREET DEPT 3400 W Q1 6T ST ADDRESS IwES7ETEL�l Ef °60740267 (S1 f 11 ,'1-2141 CITY STATE ZIP PHONE 4,,11 6230000117 2 893 54% 12/0912008 10:50arr CUSTOMER TO COMPLETE 7015080 SFIGE (:HRE (lTn BK 11 1.00 2 74,99 74.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government A5encies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Stlb -iofal ?4.99 sales tax exemption law of the state property as indicated below and/or purchaser is 7.00% Ti,x 0.00 indicated below and understands engaged in the business of agricultural production of Tut,/ 71.99 and agrees with the Genera! I'SC Car d 74.99 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or the applicable statement of the other agricultural production items purchased free of Autho:009252 Reft:0909500283 respective state printed on the PO #:winter' boats reverse side of this form. tax, as defined by state law, and as indicated below. Chan 0. 00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Rack STATE: understand they may be liable for payment of all taxes Buyer .rcknrw7.edses the r eceiNt of a eDne (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` I COMPLETE REVERSE SIDE) copy of this 5a1es 51iv and the Pur'cha °,.e D a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) f Resale Under penalty of perjury, signee swears the the described mitrchandisP shall he in Government information on this statement is true and correct in accordance with the Cardholder Asreemen Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other provisions as allowed under state Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity# Livestock Call 600 968 0734 within dayr, to 1 Exempt Organization (Entity Fertilizer /Ag richemicals NC: only DOT and US Government are exempt comp let e a survey and be entered in zl Resale (Sales Tax Permit Iuenthly drawins for a chanc to win a Consumed in Production (KS) $2500 517app i n s tngredient or Component Parts (KS) (Awarded as Gift Car NO RLIRCHASE OR SURVEY NECESSARY. Ends 9/30/09. Other: Y#YY #YY #YY #YY #YYYYY #tY #3YY8 CUSTO R SIGN URE:(REQUIRED) I MGR. APPROVAL R X USE AREA ONLY CASH CHECK VISA MIC DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY QWW yC0 P.O. Box 9020 Tractor Surely Colilp at, y Des Moines, IA 50368 -9020 7375 East Pleasant St. Nable5ville, IN 46060 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317) 776 -1883 6035 301# 3333 CARMEL. STREET DEFT NAME 3400 W 131ST ST WES'TFIELD IN 460748267 ADDRESS (317) 571 -2141 624 624000050 2 1053621 CITY STATE ZIP PHONE 11/26/2m 02 :54pp1 CUSTOMER TO COMPLETE 7157002 BOOT WETL MUCK 10 BR 1.00 99,95 9935 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government AsI°rlcies The undersigned certifies The undersigned party certifies their exemption from Subtotal 99,95 compliance with the agricultural payment of sales and use tax on tangible personal 7.00: Tax 0,00 sales tax exemption law of the state property as indicated below and /or purchaser is Total 9Y,95 indicated below and understands engaged in the business of agricultural production of TSC Card 99,95 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Acc t$: t t t t s x x:6104 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Autht:026297 Reft:2613544427 the applicable statement of the other agricultural production items purchased free of FI0 4:112608 respective state printed on the tax, as defined by state law, and as indicated below. Chance 0,00 reverse side of this form. Cash flack 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 Buyer acknowledses the receipt of a (REQUIRED) due on the purchase price for the goods as allowed byi• ed (Exceptions: Georgia, New York &Kentucky state law should such goods be used or consumed in COFY of this sales slip and the Purchase o COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. f PURCHASER IS ENGAGED IN: (REQUIRED) the described merchandi5e Shall be in Resale Under penalty of perjury, signee swears the accordance with the Ca dhaldZ'sr nt. Gove rnment information on this statement is true and correct in Exempt organization every material manner. A willfully false representation [I Agricultural Production of exemption will cause the purchaser to be subject to SisnaIUPe❑ Dairy Production penalty and /or other provisions as allowed under state F1 Livestock Production F1 Floriculture /Aquaculture Production law. i r Other. ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Cali 800 -968 -0734 within 7 days to Livestock Injestibles or Injectibles Exempt Organization (Entity complete a survey and be entered in a NC: only DOT and US Government are exempt F Fertilizer(Agrichemicals I11Cir}t'hlY draWinS for a chance to wilt a Consumed in Production (KS) Resale (Sales Tax Permit 2500 shopp i nil 5p r erg (Awarded as Gift Card) NO Pt1R01ASE Ingredient or Component Parts (KS) OR SURVEY NECESSARY, Ends 9 ✓30/09, Other: tt #E #E #E #E #333#3 CUSTOMER SIGNATU FIE: (REQUIRED) MGR. APPROVAL X USE*SHADE AREA ONLY CASH" ,CHECK 7 1' VISA M /C DISCOVER TSC CHARGE ACCOUNT NO. CH EXCH. DATE 4 DESCRIPTION Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMITTSC BUSINESS ACCOUNT Toff PAYMENTS TO: TRACTOR SUPPLY COMPANY \W S U PftyC� P.O. Box 9020 I, °a. trr SIAPI lY COniPanY Des Moines, IA 50368 -9020 18160 U.S. North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number W i t' ie.td, IN 46p74 (317) 1867 3505 6035 301 NAME C(iRMEL STREET DEPT 3400 W 131 ST Sl' ADDRESS WESTFILI_.0 IN 460740267 (317) 571-2141 CITY STATE ZIP PHONE 431 62M00009 `D 888499 11 /20/2008 03: 2X tri CUSTOMER TO COMPLETE n% 6 QUILT WEST JK 81_.K x 1 00 fI 76 ,96 ?6,96 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Gaveriment ASentieS The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 76.96 sales tax exemption law of the state property as indicated below and /or purchaser is 7,00% Tax 0.00 indicated below and understands Total 76.96 engaged in the business of agricultural production of and agrees with the General T:': Card 75.96 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Acct i x x a x s f 5914 resale and/or uses the farm machinery, equipment or the applicable statement of the Alit h#:0 ?r' R00:2007292890 respective state printed on the other agricultural production items purchased free of p8 r'arh� pf.•fer reverse side of this form. tax, as defined by state law, and as indicated below. Chrknse 0 00 PRODUCT.IS US r D IN THE FOLLOWING The undersigned party further certifies they Ca`h Back STATE: understand they may be liable for payment of all taxes Sltyet aCltnowled3es the receipt of a contriz (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 i6e d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. COPY of this scales slip and the purChaSe 0 PURCHASER IS ENGAGED IN: (REQUIRED) the �fesc'r:EbeJ nIr rrhandiS hat be e t3r� s in Resale Under penalty of perjury, signee swears the d �tnt_r with the ndi5 hal A in nt. 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 •Snature' Livestock Production law. F1 Floriculture /Aquaculture Production Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock In'estibles or In ectibles Call. 800 within 7 dears to I 1 Exempt Organization {Entity NC: only DOT and US Government are exempt cuitiPle {'e a sttrvey and be entered ed .in a Fertilizer /Agriohemicals IliOltillY dril'dFinS for d chance its Win d F] Consumed in Production (KS) Resale (Sales Tax Permit# $2500 shoppins spree. Ingredient or Component Parts (KS) (Awarded a5 Gif Cara) NO PURCHASE OR SURVEY NECteSSARY, Ends 9/30/09. Other: COST MER SIGNATURE: (REQUIRED) p MGR. APPROVAL 1C j` L.r n J q X USE AREA ONLY CASH CHECK VISA M!C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00405 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYM ENTS TO: 17 TRACTOR TRACTOR SUPPLY COMPANY IYC� P.O. Box 9020 Tractor Supply CDmipan Des Moines, IA 50368 -9020 2375 East Pleasant St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville, IN 45060 6035 301 317) 776-1883 NAME 624 624000050 2 1053619 11/26/2008 02:53p ADDRESS I t s SPECIAL ORDER CONTRACT s## Special Order a: 524052671 CITY STATE ZIP PHONE CARMEL a'I REET DEPT 3400 W 131ST ST WESTEIELD IN 460748267 CUSTOMER TO COMPLETE (317) 571 -2141 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 0222220 48X32 The undersigned certifies The undersigned party certifies their exemption from 1,00 8 94.99 84,99 NT compliance with the agricultural payment of sales and use tax on tangible personal Government Agencies 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 Subtotal and agrees with the General 7,00% Tax 0,00 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or Total 84,99 the applicable statement of the Deposit 84.9'5' respective state printed on the other agricultural production items purchased free of TSC Card 84 99 reverse side of this form. tax, as defined by state law, and as indicated below. Acct s s s 4753 The under art further certifies the Au�tha:12255 Ref PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty y STATE: understand they may be liable for payment of all taxes PO t:1 12608 (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 Cash Bac COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. BALANCE DUE: 0 00 PURCHASER IS ENGAGED IN: (REQUIRED) Buyer aclnowlerjses the receipt Of a GOfiPle Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in" d Exempt organization every material manner. A willfully false representation copy of this sales 51ir and the Purchase o Agricultural Production of exemption will cause the purchaser to be subject to F Dairy Production penalty and /or other provisions as allowed under state the described merchandise shall be in C] Livestock Production accordance with the Cardholder Agreement, Floriculture /Acluaculture Production) law F Other: aiSnatUr'e: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Paris Government Agency (Entity Livestock Injestibles or Injeetibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit #f Ingredient or Component Parts (KS) Call 800 968 °0734 within 7 days to complete a survey and be entered in a other: ttanthly drawing for a chance to win a 52500 shoppins spree. CUSTOMER SIG A MGR. APPROVAL (Awarded as Gift Card) NO PURCHASE /1. `i OR SURVEY NECESSARY. Ends 9/30/09. X USE SHADED AREA ONLY WHEN IS INOPERATIVE. CASH CHECK VISA M /C' DISCOVER TSC CHARGE ACCOUNT NO: CHG. EXGH. DATE' Ll e ITEM NUM13ER D IESCRIPTION I UNIT PRICE,- Form No. 99.00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT NO TI NC T011 PAYMENTS TO: TRACTOR SUPPLY COMPANY OWT co P.O. Box 9020 Tractor Supply Coripanr Des Moines, IA 50368 -9020 2375 East Pleasant St TSC TEAM MEMBER TO COMPLETE Noblesville, IN 46060 Please include 16 Digit Account Number (317) 776-10E3 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST 5T ADDRESS WESTFIELD IN 460749267 (317) 571 -2141 CITY STATE ZIP PHONE 624 624000103 2 1053415 11/26/2008 10;22am CUSTOMER TO COMPLETE 7385493 S WTSHIRT HOODED NY R 1.00 e 1 -6 16.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res. P rice; 21 .99 The undersigned certifies The undersigned party certifies their exemption from Government Asenr.ies compliance with the agricultural payment of sales and use tax on tangible personal 7355493 5WTSHIRT HOODED NY R sales tax exemption law of the state 1 00 16.99 16.99 NT property as indicated below and/or purchaser is indicated below and understands engaged in the business of agricultural production of Res. Price: 21,99 and agrees with the General Government Asencies food or fiber, horticulture, aquaculture of floriculture for r Exemption Statement at right and 7385493 SWTSHIRT H00DED NY R resale and /or uses the farm machinery, equipment or r the applicable statement of the 1.00 16.99 16,97 NT respective state printed on the other agricultural production items purchased free of Res, Price: Z1 .99 reverse side of this form. tax, as defined by state law, and as indicated below. Government Asencies PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 7151991 BOOT WETL MUCK 9 BR understand the be liable for payment of all taxes 1.00 99.95 -99,95 XT STATE: y may a p y Govern'meat Asencies (REQUIRED) due on the purchase price for the goods as allowed by 7157.002 BOAT WETL PLUCK 10 BR, (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. 1,00 99.95 99.95 NT PURCHASER 4S ENGAGED IN: (REQUIRED) Government Asencies Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in Subtotal S0 97 Exempt organization every material manner. A willfully false representation 7.00% Tax 0.00 Agricultural Production of exemption will cause the purchaser to be subject to Total 50.97 Dairy Production penalty and /or other provisions as allowed under state TSC Card 50.97 Livestock Production law. Acc t t 3 t3 3 3 t t t t t t t 4795 F Floriculture /Aquaculture Production Au tho 07.63371 Ref .2609223991 Other: PC 1; ron Chanse 0.00 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Cash Back k Farm Machinery/Repair Parts Government Agency (Entity Livestock e. I 1 Exempt Organization (Entity Buyer ackitowledses the receiFt of a comPl Fertilizer /Agrichemicals NC: only DOT and US Government are exempt tl Resale(SalesTaxPermit# ropy ®f this sales slip and the purchase Consumed in Production (KS) Ingredient or Component Parts (KS) the described merchandise shall be in Other: accordance with the Cardholder Agreement. CUSFOS fUA:(REO MGR.APPROVAL 5iynature; X SHA USE AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK" VISA '.M /C DISCOVER TSC CHARGE ACCOUNT NO. CHG.. EXCH. -DATE 31 ITEM NUMBER DESCRIPTION UNIT PRICE Form No. 99- 00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TI�AC�OR® PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPPLY C0 P.O. Box 9020 Tractor Supply ConlPanY Des Moines, IA 50368 -9020 18160 U, S. 31 Nor TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wus tf-ield, IN 46074 6035 301 317) 867 -3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 571 -2141 CITY STATE ZIP PHONE 431 431000179 2 889661 11 /24/2008 02:11 Pin CUSTOMER TO COMPLETE 64?0397 JKT ARCTIC BLK 42T CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1. 9 99 96 NT Govee rnment Asen sencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 99.96 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00•x, Tax 0,00 indicated below and understands Total 99,96 and agrees with the General engaged in the business of agricultural production of g food or fiber, horticulture, aquaculture of floriculture for TSC Card 99,96 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct t t t t t t t 1 t 6112 the applicable statement of the Autht :024686 Reft:2413113696 respective state printed on the other agricultural production items purchased free of defined b l d indicated t:112408 reverse side of this form. tax, as eney state law, an as ndicated below. Chanse 0.00 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Buyer ar.kllowledses the receiPt o.f a contp le (Exceptions: Georgia, New York Kentucky state REVERSE SIDE) state law should such goods be used la consumed in- coPY of this sales slit and the Pur chase o a taxable manner as defined by state laws. 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 Asreenien t 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 Si sna tune Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) #2 223# #t3#l322t# #22tit22##iY22222tit2 Farm Machinery/Repair Parts Government Agency (Entity Livestock Iniestibles or Injectibles Exempt Organization (Entity Call 800- 968 -0734 within 7 days to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt conlPlete a survey and be entered in a Resale(SalesTaxPermit# monthly drawins for a chance to win a Consumed in Production (KS) $2500 shoPPins 5Pree, Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE Other: OR SURVEY NECESSARY. Ends 9/30/09, tit #2 #2#2 #ii #2 #t2tY2 ##22 #232#2#2 #i #2 CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL R EMOTTSC BUSINESS ACCO UNT TC�R� PAYMENTS T TRACTOR SUPPLY COMPANY QWWJ%yC0 P.O. Box 9020 Trai=tor SuerlY COiileanY Des Moines, IA 50368 -9020 2375 East Pleasant St, TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville, IN 46060 (317) 776 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WE5TFIEi_0 IN 460748267 (317) 571 -21 41 CITY STATE ZIP PHONE 624 624000104 2 1 052535 /1 /2412006 02: 09eni CUSTOMER TO COMPLETE 7151991 BOOT WETL MUCK 9 BR -1, l? 99 95 -99 ,95 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Governgrent Asencie5 The undersigned certifies The undersigned party certifies their exemption from S u b total compliance with the agricultural payment of sales and use tax on tangible personal Subtotal -99.95 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 °99.95 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card -79. Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acc t# #6146 the applicable statement of the other agricultural production items purchased free of Autho: Ref 0: respective state printed on the tax, as defined by state law, and as indicated below. ChanSe 0.00 reverse side of this form. Cash Rack PRODUCT IS TO RE USED IN THE FOLLOWING The undersigned party further certifies they Buyer acknowledses the receiet Of a cr7r'�le STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by CORY of this sales slip and the Purchase o (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed In COMPLETE REVERSE SIDE) f a taxable manner as defined by state laws. the described merchandise shall be in PURCHASER IS ENGAGED IN: (REQUIRED) aCCOrdanCE' wi the Cardholder A 3reenien# C] Resale Under penalty of perjury, signee swears the 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 Signature: Dairy Production penalty and /or other provisions as allowed under state Livestock Production L] Floriculture /Acluaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Call 600 968 -0734 within 7 days t0 Livestock Injestibles or Injectibles Exempt Organization (Entity Cowplete a survey and be entered in a NC: only DOT and US Government are exempt neon thlY drawins for a chance t0 win a F Fetiilizer /Agrichemicals $2500 51-opt-ing 5I °ree, Consumed in Production (KS) Resale (Sales Tax Permit# (Awarded as Gif Card) NO PURCHASE Ingredient or Component Parts (KS) OR SURVEY NECESSARY. Ends 9/30/09, Other: Enter Store 4 0624 CUSTOM IGNATURE:(REQUIRED) I MGR.APPROVAL 1 X USE SHADED AREA ONLY WHEN REGI CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE. ITEMNIUMBER D ESCRI P TI O N Form No. 99 -00401 (12105) CUSTOMER ORIGINAL P� REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SU ILYC0 P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 7375 East Pleasant 5t. TSC TEAM MEMBER TO COMPLETE Nubiesville, IN 4606,0 Please include 16 Digit Account Number (3117) 776 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (:117) 571 -2141 CITY STATE ZIP PHONE 624 624000104 2 1 050460 11120/2008 Q3: 3P6i 4 4 _7443 CUSTOMER TO COMPLETE 7151991 BOOT` l c art 1.00 P 99.95 99.95 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption from 7152010 BOOT WEIL MUCK 11 DC compliance with the agricultural payment of sales and use tax on tangible personal 1,00 99.95 99.95 NT sales tax exemption law of the state property as indicated below and /or purchaser is Government Asenc ies indicated below and understands engaged in the business of agricultural production of 7152002 BOOT UETL BUCK 10 BR and agrees with the General 1.00 C 99.95 99,n 95 SIT Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Governnl�:nt Asencies the applicable statement of the resale and ult uses the farm machinery, equipment or 7385493 SUTSHIRT HOODED NV R respective state printed on the other agricultural production items purchased free of 5, Q0 ''1 .99 109.9a NT reverse side of this form. tax, as defined by state law, and as indicated below. GovernmentLAsencies PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they may be liable for payment of all taxes Sttbtuta1 409.80 STATE: understand they Y P Y 7, 0 Tax 0, 00 61 (REQUIRED) due on the purchase price for the goods as allowed by TDt0 409.80 (Excepti Geor New York a Kentuck state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. TSC Card 409.90 AcF_t: aattss>ca stas4795 PURCHASER IS ENGAGED IN: (REQUIRED) L11'h� 020181 Ref :2014014332 Resale Under penalty of perjury, signee swears the A AL' #:ron F7 Government information on this statement is true and correct in PO Exempt organization every material manner. A willfully false representation Chan5e 0.00 Agricultural Production of exemption will cause the purchaser to be subject to Cash Back Dairy Production penalty and /or other provisions as allowed under state Livestock Production Buyer acknowledses the receipt of a come -le Floriculture /Aquaculture Production law. tTd Other: COPY of this sales slip and the Purchase a ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) the described merchandise shall be in Farm Machinery/Repair Parts Government Agency (Entity accordance with the Cardholder Asreement. Livestock Iniestibles or Injeetibles Exempt Organization (Entity Fertilizer /Agrichemicals INC: only DOT and US Government are exempt S ignature: Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: ttllLtitll '&tit #titttltit3Ettittt113ii. CUSTOMER 5 A :(REOUlRE MGR. APPROVAL X f GASH CHECK VISA `MlC, p3SCOVER TSC CHARGE AGCOUNT N0. CHG. EXCH. DATE i O ITEM NUMBER Form No. 99-00401 (112105) CUSTOMER ORIGINAL REMITTSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY co P.O. BOX 9020 Tractor SLIPPtY CotltPnr m II'LY Des Moines, IA 50368 -9020 18160 U.S, 31 North OBER TO_COMPLETE Please include 16 Digit Account Number Westfield; IN 4eA74 6035 301 (317) 967-3505 NAME CAfif'lEL STREET DEPT 3400 W 13157 S r ADDRESS WESTFIELD IN 160748267 (317) 571 -2141 CITY STATE ZIP PHONE 431 431000179 2 889934 1 1 /25/2008 03 CUSTOMER TO COMPLETE 021'2220 SPECIAL, ORD ARTICL -1.00 99,98 -99,98 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural `Subtotal payment of sales and use tax on tangible personal -99,98 sales tax exemption law of the state property as indicated below and /or purchaser is 7,00y 'pax 0.00 indicated below and understands Total -99,98 and agrees with the General engaged in the business of agricultural production of rSC Card -99,98 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct 0: x x s s t 4 4837 the applicable statement of the other agricultural production items purchased free of Auth4: Refs; respective state printed on the tax, as defined by state law, and as indicated below. Chanse 0.00 reverse side of this form. Cash Sack PRODUCT ISTO BE USED IN THE FOLLOWING The undersigned party further certifies they STATE: understand they may be liable for payment of all taxes c d Betyer acknowledses the receipt of a "4 L (REOUIREO) 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 COPY Of this sales slip and the PUrci`hdSe O COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. t•hr d e s c r i b e d Inerchandise `aihal i be in PURCHASER IS ENGAGED IN: (REQUIRED) accordance w ith the Cardholder A3reEpiE`nt, p Resale Under penalty of perjury, signee swears the El 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 Si.snature ���r Dairy Production penalty and /or other provisions as allowed under state r Livestock Production Floriculture/Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Call 800- 968 within 7 days to Livestock lnjestibiesorinjectibles Exempt Organization(Entity# complete a survey and be entered in a Fertilizer /A 9 riche micals NC: only DOT and US Government are exempt monthly drawins -for a chance to wilt a Consumed in Production (KS) Resale (Sales Tax Permit $2500 5hopp' ins spree, (Awarded a5 Gift Card) NO PURCHASE Ingredient or Component Parts (KS) OR SURVEY NECESSARY, Ends 9/30/09. p Other. Enter Store 4 0431 CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X AREA CASH CHECK VISA MIC DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE UNIT PRICE QUANTITY ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 10 TTi PAYMENTS TO: su TRACTOR SUPPLY COMPANY LYCO P.O. Box 9020 Tractor Supply Cowparly Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number- r Westf field, IN 46074 6035 301# (317) 867-3505 NAME 431 431004172 2 898303 11/1 09:25am ADDRESS t#t SPECIAL ORDER CONTRACT t #t Special Order a; 431052047 CITY STATE ZIP PHONE CARMEL STREET I)E1 3400 W 131ST ST WESTFIELD IN 460748267 CUSTOMER TO COMPLETE (317) 571-21141 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: The undersigned certifies The undersigned party certifies their exemption fro 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 0222220 DKB 4XLT indicated below and understands engaged in the business of agricultural production of 1.00 99.98 99.98 NT and agrees with the Genera! Coout A3encies Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for veraw resale and /or uses the farm machinery, equipment or the applicable statement of the Subtotal respective state printed on the other agricultural production items purchased free of 7 UO� Tax O,OU reverse side of this form. tax, as defined by state law, and as indicated below. Total 149.96 The unde art further certifies the De' 0Si. t 149.96 PRODUCT IS TO BE USED IN THE FOLLOWING g P y y 144 °6 STATE: understand they may be liable for payment of all taxes TSC Car (REQUIRED) due on the purchase price for the goods as allowed by Aec t# t t t t t t a t t 4837 (Exceptions: Georgia, New York Kentucky state law should Such goods be used or consumed In Authl- 019065 R040:1908245048 COMPLETE REVERSE SIDE) FAO er is a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Chan 0 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 BALANCE DUE: 0,00 Agricultural Production of exemption will cause the purchaser to be subject to Buyer acknawledses the receirt of a costrle Dairy Production penalty and /or other provisions as allowed under state f E] Livestock Production COPY Of this ]ales slip an the Furc6ase o Floriculture /Aquaculture Production law. f Other: the described merchandise shall be in ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) accordance with the Cardholder A3rEerne.nT, Farm Machinery/Repair Parts Government Agency (Entity Livestock Iniestibles or Iniectibles Exempt Organization (Entity `Ii 3na1 ure: Fertilizer(Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: #tti #itttt2itttttt ##t# #11111 ##tt #tt# ttttttttt #t #ttttttttttttt #tt #tt #ttt Call 800 -960 -0734 within 7 days to CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL colaple'te a _uPve and be e ltered in a ntanthly drawins for a chance to win a o X SHA D .E DAREA ONLY WHEN REGISTER IS INOPERATIVE CASH- CHECK VISA M/C -DISCOVER TSC CHARGE ACCOUNT NO. CHG: V'EXCH DATE r ITEM NUMBE R NON A DESCRIPTIO TAX CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TR1�C�OR® PAYMENTS TO: TRACTOR SUPPLY COMPANY S� Y�� P.O. BOX 9020 i'ractor Suprly Cou)pany Des Moines, IA 50368 -9020 1 U.S. 31 Nor TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Ue5tf field, IN 46074 6035301 (317) 867 -3505 NAME CARREL STREET DEFT 3400 I.d 131ST ST ADDRESS blESTFIELD IN 460748267 (;517) 571-2141 CITY STATE ZIP PHONE 431 623000089 2 891585 1:'/02/2008 10: 21 an) CUSTOMER TO COMPLETE 5001679 SUSPENDERS BL' 1.00 P 7,99 7,99 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 7,99 sales tax exemption law of the state property as indicated below and /or purchaser is 1 00% I ax 0.00 indicated below and understands engaged in the business of agricultural production of Total 7.99 and agrees with the General TSC Card 7,99 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or the applicable statement of the Act tht:002307 Ref *:0209213378 respective state printed on the other agricultural production items purchased free of PO x:120208 reverse side of this form. tax, as defined by state law, and as indicated below. Chanse 0,00 PRODUCT IS TO BE US D IN THE FOLLOWING The undersigned party further certifies they Cash Bac STATE: understand they may be liable for payment of all taxes (REQUIRED) due on the purchase price for the goods as allowed by Buyer acknowledses the receipt of a conip).e (Exceptions: Georgia, New York Kentucky state law Should such goods be used Or consumed in' 3 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy of this sales slit and the Purc1 o PURCHASER IS ENGAGED IN: (REQUIRED) f (resale Under penalty of perjury, signee swears the the described nterchandi.se shall be in Government information on this statement is true and correct in accordance with the Cardholder Asreemeat. 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 5i.snatUre: Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Cal 800­968 wi thi ii 7 da ys to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt cooiplet•e a survey and be entered in a Consumed in Production (KS) Resale (Sales Tax Permit monthly drawins -for a chance to win a ?500 shoppins spree, In diem or Component Parts (KS) (Awarded -mss Gift Ca. U P' ther: kCHASE O 0r. SI Rti''.' iYC .c SAP 0 /30/09 CUSTO ER SIGNATURE: (REQUIRED) MGR. APPROVAL _-"L :;z X V USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L] I QUANTITY ITEM NUMBER DESCRIPTION Form No. 99-00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO: TRACTOR SUPPLY COMPANY SUPnYC0 Box.9020 Tractor St!ppl.Y Cootpany Des Moines, IA 50368 -9020 18160 U,5- 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Wtt tf ie ld, IH 4607; 6035 301 (317) 867 -3505 NAME 431 4310001 2 891309 12/01/2008 09:53ant ADDRESS $34 SPECIAL ORDER CUt1 l'l<ACT 3 t i SPecihl Order 8: 431052050 CITY STATE ZIP PHONE CARMEL STREET DE PT 2400 U 1315T ST WESTFIELD IN 460748267 CUSTOMER TO COMPLETE (31 7) 571 -2141 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 0222220 RIDS The undersigned certifies The undersigned party certifies their exemption from 1,00 2 7,•50 79,50 compliance with the agricultural payment of sales and use tax on tangible personal Reg. Price: 99.50 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 Subtotal and agrees with the General 7.00 Tax 1 55 Exemption Statement at right and food or fiber, horticulture, aquacuiture of floriculture for Lot ,1 85 07 resale and /or uses the farm machinery, equipment or the applicable statement of the Deposit 85.07 respective state printed on the other agricultural production items purchased free of TSC Card 85,07 reverse side of this form. tax, as defined by state law, and as indicated below. Rcc t. x 3 3 3 t 3 3 3 t 3 3 3 35932 The under art further certifies the Auth *:001046 Reft:0100530205 PRODUCT IS TO BE USED IN THE FOLLOWING g p arty Y STATE: understand they may be liable for payment of all taxes I:0 *:parks (REOUIRE3) due on the purchase price for the goods as allowed by C 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} BALANCE DUE: 0. Resale Under penalty of perjury, signee swears the Bctyer acknowledges the receipt of a comple Government information on this statement is true and correct in =d Exempt organization every material manner. A willfully false representation copy cif 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 the described Pterchandise shall be in Livestock Production accordance with the Cardholder Rsreerten f Floriculture /Aquacultu re Production law. Other: 5i,sncttttre; ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm,Machinery /Repair Parts Government Agency (Entity Livestock Iniestibles or Iniectibies Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Resale(SalesTaxPermit# 33813 t Y3333888383 .d.S3:tt %S:Kt�9333L'fitrBR F Consumed in Production (KS) 3E8333 #3333Y33833Y33tt33tE333x33>i33S Ingredient or Component Parts (KS) Call 800 -968 -0734 within 7 days to complete a slarvey and be etrtered in a Other: Itton l thly drawiris for a chance to win a $2500 shovpins spree. C U S T R SIGNATURE: (REQUIRED) MGR. APPROVAL (Awarded us G i F t Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9/30/09. USE SHADED AREA ONLY WHEN REGISTER IS CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO, CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -o0401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT ��R® PAYMENTS TO: TRACTOR SUPPLY COMPANY S co P.O. Box 9020 rract•er S-1-1y CorteanY Des Moines, IA 50368 -9020 181 60 U-S, 31 Nor TSC TEAM MEMBER TO COMPLETE "t' 867- 50 5 Please include 16 Digit Account Number •11 6b7�3505 6035 301 NAME LFfRI€Ll.. 5 rREF f T DEPT 3400 U 131 ST UESTEIEI_l7 IN 460745267 ADDRESS (31r') 5r1 -1141 CITY STATE ZIP PHONE 431 786000104 2 8134362: 11!20/200,2' 0Z:S1Pn1 CUSTOMER TO COMPLETE 3187285 UR BOND slJPER GLUE 1.00 0, 0,s9 N'r CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Governuleat Asencies The undersigned certifies The undersigned party certifies their exemption from Subtotal p yy compliance with the agricultural payment of sales and use tax on tangible personal 7.00% lax sales tax exemption law of the state property as indicated below and /or purchaser is Total 0.00 indicated below and understands engaged in the business of agricultural production of TSC, 0,99 and agrees with the General g p T'(- Card Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Acc•ts $$aa$x$$ast#5406 0,yy the applicable statement of the resale and /or uses the farm machinery, equipment or Authv :020544 Ref�:2013504702 respective state printed on the other agricultural production items purchased free of PO .f S reverse side of this form. tax, as defined by state law, and as indicated below. Cflanse 0100 The unde art further certifies the Cash E`ick PRODUCT IS TO BE USED IN THE FOLLOWING 9 p ar t y Y STATE: understand they may be liable for payment of all taxes BUYel. aL. knowl edsey tfllr receipt of a cu"�°itl le (REQUIRED) due on the purchase price for the goods as allowed by d (Exceptions: Georgia, New York Kentucky state law should such goods be used Or consumed In EUPY or tlli5 5 kle5 slif' clad 1112 rUrCfktSf 0 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. p PURCHASER IS ENGAGED IN: (REQUIRED) the described n;erchandise Shall be in Resale Under penalty of perjury, signee swears the acLDrdance with the Cardholder Asreel;tent, 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 S Dairy Production penalty and /or other provisions as allowed under state t5nature Livestock Production Floriculture /Aquaculture Production law. Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) $$3 #S #$E #88$ #I #$Et8 #8$8# Farm Machinery/Repair Parts Government Agency (Entity C] Livestock x100- .643 -0734 within 7 daYS to Livestock Injestibles or Injectibles Exempt Organization (Entity Cramp fete a 5LIrveY and he entered in a F-1 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt IitorithlY drawing for a chanc io wi.n a Consumed in Production (KS) Resale (Sales Tax Permit# $2500 shor''p ins spree, Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE. OR SURVFY NECESSARY, Ends 9/30/09, Other: 48# Y#. t3YGEEA$$$YttifYttiY'ttxYBit><i "SIGNATU D) MGR. APP ROVAL X USE S1 MLY WHEN REGIS I E IS INO PERATIVE. CASH CHEC VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT ��R� PAYMENTS TO: TRACTOR SUPPLY COMPANY S �X�o P.O. Box 9020 Tra,r -tt'ir Surrly Company Des Moines, IA 50368 -9020 18160 U. 31 Nor TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number West'f field, IN 46074 6035 301# 1317) 967 -3505 NAME 431 78600e104 2 99339? 12/08/2000 03:47prt ADDRESS t.t 5i'CC'IA1. URDLR CONTRACT 333 CITY STATE ZIP PHONE Srecial Order 431052065 CARMEI._ 5TRCI T DEPT 3400 W 131ST ST CUSTOMER TO COMPLETE UESTFILLD IN 460748Z67 (317) 571 -2141 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 0222220 SAND BIB DRN 46x34 The undersigned certifies The undersigned party certifies their exemption from 1.00 P 84.00 B4.00 NT compliance with the agricultural payment of sales and use tax on tangible personal Public Utilities 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 SubtOt;11 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 7 001% Tax 0,00 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Total 84.00 the applicable statement of the other agricultural production items purchased free of 0er05it 84.00 respective state printed on the tax, as defined by state law, and as indicated below. TSC Card 84,00 reverse side of this form. Acct *:443 t3s3s3s* 16130 The under art further certifies the At.Itht:008306 Reff- ;0814470071 PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty Y STATE: understand they may be liable for payment of all taxes d'' 4- AVIS (REQUIRED) due on the purchase price for the goods as allowed by Chanse 0.00 (Exceptions: Georgia, New York Kentucky state law should Such goods be used or Consumed In Lash Bac COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) BALANCE DUI:. 0100 Resale Under penalty of perjury, signee swears the Buyer ackiiuwled9es the receipt of a cotttrle Government information on this statement is true and correct in' 1 Exempt organization every material manner. Awillfully false representation cure of this sales slip and the Purchase o Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production the described merchandise shall be in Livestock Production penalty and /or other provisions as allowed under state FloriculturelAquaculture Production law. accordance with the Cardholder Asreemerit Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) 513 a t LI F Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization {Entity FertilizedAgrichemicals NC: only DOT and US Government are exempt 48i4YE434333342335333 :i83d3.t�4344 #h'$d� Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Call 800 9613 -0734 within 7 days to Other complete a survey and be entered in a monthly drawins far a chaltce to win a x+2500 shoppins spree, CUSTOMER SIGNATURE: E MGR. APPROVAL (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9/30/09, al X CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG, EXCH" DATE IT M NUMBER DESCRIPTIO Form No. 99 -00401 (12105) CUSTOMER ORIGINAL Prescribed by State Board of Accounts City Firm 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)) 12/30/08 $84.99 12/30/08 $1,155.12 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 NO.' WARRANT NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $1,240.11 ON ACCOUNT OF APPIR PRIATION FOR Carmel Street Department PO# 1 Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 43- 560.01 $84.99 1 hereby certify that the attached invoice(s), or 18753 43- 560.01 $1,155.12 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 ednesday, D� ber 31, 2008 f 1.`.. f S"%Stre'kt;Comm issio Title Cost distribution ledger classification if claim paid motor vehicle highway fund