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Home My WebLink About173573 06/10/2009 a F CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 I 0 ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $516.88 CARMEL, INDIANA 46032 PO BOX 689020 oM DES MOINES IA 50368 -9020 CHECK NUMBER: 173573 CHECK DATE: 6/10/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPT 2201 4237000 .05 -0860 516.88 6035 3012 0005 -0860 page 1 of a TX 7 D1130000000 I VSLTMY%fx BUSINESS ACCOUNT 0000508 e SUMMAFY� QvJ 3Q�� J�'Q�j�d� p i? ,dl'�eav, Previous Balance 506.14 Closing Date 05/19/09 Payments 0 .00 Next Closing Date 06/18/09 CARMEL STREET DEPT Credits 0.00 Payment Due Date 06/13/09 CINDY Purchases 1,845.84 3400 W 131ST ST Debits 0.00 Current Due 1,845.84 WESTFIELD, IN 46074 6267 FINANCE CHARGES 0.00 Past Due Amount 506.14 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 2,351-98 Credit Available 2,898 New Balance 2,351.98 CURRENT ACTIVITY Transasiion Locationt ffill MAN Am�aUrtt 3a11a' De§crlPort w MAY 1 GOODS AND SERVICES NOBLESVILLE IN 86.43 MAY 13 GOODS AND SERVICES WESTFIELD IN 132.96 TOTAL 6035301200074803 $219.39 MAY 7 GOODS AND SERVICES WESTFIELD IN 69.99 MAY 8 GOODS AND SERVICES WESTFIELD IN 10.49 MAY 8 GOODS AND SERVICES WESTFIELD IN 99.98 TOTAL 6035301202895874 $180.46 APR 29 GOODS AND SERVICES WESTFIELD IN. 59.99 TOTAL 6035301202896021 $59.99 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL Subject to Periodic Bill PERCENTAGE Subject to Periodic Billing PERCENTAGE Finance Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 29 0.00 0.00 .00000 32 0.00 This Accouni 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 tailed a grace period on the periodic finance char 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 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 for that billing period. We do not calculate periodic finance charges for the payment due date. 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, an 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 of days in the billing and by the applicable daily periodic rate. advances, and different promotional balances. The result u the periodic finannce ce c hargc�es for that balance. For each purchase 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 credi or period. Then do the same thing for the Balance Subject to Finance Charge for p ayrents 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. It the rate on a balance is a daily rate we use an average daily balance method (including neat 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 dally 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 y 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. Alternate Balance Sub ject to Finance Char Calculation Method. If the a Your name and account number. The dollar amount of the suspected error. front of your staterent as a message stating this account is subject to the o Describe the error and explain, if you can, why you believe there is an Alternate Balance Subject to Finance Charge Calculation Method we use a error. If you need more information, describe the item you are unsure two -cycle average daily balance method (including new transactions) for about. Important Payment Instructions. Copy Fee. We charge $5 for each copy of a billing statement that dates back 3 Crediting Payments. We must receive your payment in proper form at our months or more. We add the fee to the regular revolve credit plan balance. We processing facility by 5 p.m. local time there. If we do, it will be credited as of waive the fee if your request for the copy relates to a billing error or disputed that day. A payment received at the processing facility in proper form after purchase. that time will be credited as of the next day. Allow 5 to 7 days for payments by Payment Options Other Than Regular Mail. regular mail to reach us. There may be a delay of up to 5 days in crediting a 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. Express Payments. You can send pay €Went 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 clay. 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 wilt be debited in the amount on the check. We may do this as Tractor supply CRC 5603TV Rev. 07/08 soon as the day we receive the check. Also, the check will be destroyed. 603TV5740708-Clit page 2 of 6 TX 7 D1130000000 _o 1 9S T U�P IY� V2) BUSINESS ACCOUNT 0000509 �g CURRENT ACTIVITY a rT 8nfirt�p�'° LocatioN MAY 4 GOODS AND SERVICES WESTFIELD IN 259.99 MAY 12 GOODS AND SERVICES WESTFIELD IN m� 863.73 TOTAL 6035301202896062 $1,123.72 APR 23 GOODS AND SERVICES NOBLESVILLE IN 166.30 APR 23 GOODS AND SERVICES WESTFIELD IN 95.98 TOTAL 6035301202896120 $262.28 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. Blue Books are now available in stores. Be sure to stop by to pickup your free copy packed with product information, planning guides, comparison charts and more. It's even easier to get what you need at Tractor Supply! Now order any item available for sale online and have it shipped to your nearest store for free! Buy in bulk and save! Check out our volume pricing on fencing, feeds, clothing and maintenance, available on purchases as small as five items. See a team member for details. Remit To: Bill To: Page 3 or 6 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860C DEPT.30 1200050860 JEFF STEWART ®SuLY(;O- PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000510 Payment Due Date: 06/13/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000921430010 431000922539010 Purchase Order: SHOP AMOUNT DUE: 44.98 AMOUNT DUE: 49.99 Store: 574000431 INVOICE DATE: 04/10 /09 Store: 574000431 INVOICE DATE: 04/15 /09 PAINT T8I SPR JD GN 3449449 1.00 4.99 4.99 BOTTLE JACK 20T SHORTY 0116623 1.00 49.99 49.99 PUMP PULL UP BARREL 3957816 1.00 39.99 39.99 SUBTOTAL 49.99 SUBTOTAL 44.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 49.99 TOTAL 44.98 V Q SHIP TO: INVOICE: SHIP TO: INVOICE: 624001125721010 431000930924010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 86.43 AMOUNT DUE: 132.96 Store: 574000624 INVOICE DATE: 05/01 /09 Store: 574000431 INVOICE DATE: 05/13 /09 STRAP RATCHET 1X10 1200 3020520 1.00 14.99 14.99 RATCHET 2X27 2PK 3010575 2.00 24.99 49.98 ANCHOR FLIP 5000LB 3018272 1.00 3.29 3.29 002MTS TOWING MAGNETIC 1069332 1.00 52.99 52.99 ANCHOR FLIP SOOOLB 3018272 1.00 3.29 3.29 FLOOR JACK 2T 0116479 1.00 29.99 29.99 STRAP RATCHET 2X27 1000 3018109 1.00 14.99 14.99 STRAP RATCHET 2X27 1000 3018109 1.00 14.99 14.99 SUBTOTAL 132.96 BOTTLE JACK 20T 0116487 1.00 34.88 34.88 TAX 0.00 SHIPPING 0.00 SUBTOTAL 86.43 TAX 0.00 TOTAL 132.96 SHIPPING 0.00 TOTAL 86.43 J Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 Remit To: Bill To: page 4 or 6 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30 1200050860 JAMES BENTLEY 7suff"WICO2, PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000511 Payment Due Date: 06/13/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP To: INVOICE: 431000929101010 431000929492010 Purchase Order: Purchase Order: TRK57 TRUCK11 AMOUNT DUE: 69.99 AMOUNT DUE: 99.98 Store: 574000431 INVOICE DATE: 05107 /09 Store: 574000431 INVOICE DATE: 05/08 /09 GW POST HOLE DIGGER DIG 4433433 1.00 69.99 69.99 BOOSTER 20FT 4GAU CABLE 0476308 1.00 49.99 49.99 BOOSTER 20FT 4GAU CABLE 0476308 1.00 49.99 49.99 SUBTOTAL 69.99 TAX 0.00 SUBTOTAL 99.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 69.99 TOTAL 99.98 I V J SHIP TO: INVOICE: SHIP To: INVOICE: 431000929493010 431000926862010 Purchase Order: Purchase Order: TRUCK11 42909 AMOUNT DUE: 10.49 AMOUNT DUE: 59.99 Store: 574000431 INVOICE DATE: 05/08 /09 Store: 574000431 INVOICE DATE: 04/29 /09 BRUSH SIN WIRE FINE 1/2 3903655 1.00 10.49 10.49 FUEL NOZZLE AUTOM UNLEA 3958236 1.00 59.99 59.99 SUBTOTAL 10.49 SUBTOTAL 59.99 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 10.49 TOTAL 59.99 J Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425 Remit To: Bill To: Page 5 or 6 �TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30 1200050860 BONNIE CALLAHAN ®SuLYCp PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000512 Payment Due Date: 06/13/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP rD: INVOICE: 431000928383010 431000930744010 Purchase Order: Purchase Order: 50409 STATION43 AMOUNT DUE: 259.99 AMOUNT DUE: 863.73 Store: 574000431 INVOICE DATE: 05/04 /09 Store: 574000431 INVOICE DATE: 05/12 /09 TBX SPEC ALUM 60IN INNE 1099531 1.00 259.99 259.99 STALL MAT 4X6 RUBBER 2219003 27.00 31.99 863.73 SUBTOTAL 259.99 SUBTOTAL 863.73 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 259.99 TOTAL 863.73 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000920902010 431000920810010 Purchase Order: Purchase Order: 40809 40809 AMOUNT DUE: 35.82 AMOUNT DUE: 29.24 Store: 574000431 INVOICE DATE: 04/08 /09 Store: 574000431 INVOICE DATE: 04/08 /09 CUTOFF WHEEL 4 1/2X.045 3805344 6.00 1.99 11.94 CLAMPS 30A INS 1041685 1.00 2.99 2.99 MTL WHEEL 4X .045 X 5/8 3910157 12.00 1.99 23.88 FLAT SEAT HOSE BARB 3/ 2114376 1.00 1.29 1.29 LENS 4 1 /4X5 CLEAR PLAS 3896727 1.00 4.49 4.49 SUBTOTAL 35.82 LENS 4 1 /4XS CLEAR PLAS 3896727 1.00 4.49 4.49 TAX 0. 00 LENS GD- SHADE -10 4-1/2X- 3948257 1.-00 8.49 8.49 SHIPPING 0.00 BRUSH 6IN FINE WIREWHL 3822150 1.00 7.49 7.49 TOTAL 35.82 SUBTOTAL 29.24 TAX 0.00 SHIPPING 0.00 TOTAL 29.24 l V Please Direct Inquiries to: Phone: 800- 559 -8232 Fax: 801 779 -7425 Remit To: Bill Tot page 6 or s TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30- 1200050860 MIKE HENRICKS wrWT011 W CO PO BOX 689020 3400 W 131 ST ST BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000513 Payment Due Date: 06113109 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP TO: INVOICE: SHIP TO: INVOICE: 431000922528010 431000924910010 Purchase Order: Purchase Order: 41509 42309 AMOUNT DUE: 8.78 AMOUNT DUE: 95.98 Store: 574000431 INVOICE DATE: 04/15 /09 Store: 574000431 INVOICE DATE: 04/23 /09 NIPPLE 1 /4X2IN GALV 3149780 1.00 1.49 1.49 RATCHET BINDER 1 /4IN 3599537 1.00 47.99 47.99 THROTTLE CONTROL UNIV C 4441004 1.00 7.29 7.29 RATCHET BINDER 1 14IN 3599537 1.00 47.99 47.99 SUBTOTAL 8.78 SUBTOTAL 95.98 TAX 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 8.78 TOTAL 95.98 SHIP TD: INVOICE: 624001121154010 Purchase Order: 42309 AMOUNT DUE: 166.30 Store: 574000624 INVOICE DATE: 04/23 /09 RATCHET BINDER 1 /4IN 3599537 1.00 47.99 47.99 RATCHET BINDER 1 14IN 3599537 1.00 47.99 47.99 HOOK 1 /4IN CLEVIS SLIP 3543861 8.00 8.79 70.32 SUBTOTAL 166.30 TAX 0.00 SHIPPING 0.00 TOTAL 166.S0 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801- 779 -7425 r REMIT TSC BUSINESS ACCOUNT T=Toff PAYMENTS TO: TRACTOR SUPPLY COMPANY Su "LYCo P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield. IN 46074 6035 301 317) 867 -3505 NAME CARNEL STREET DEPT 3400 W 131ST ST ADDRESS' WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000179 2 929493 05/08/2009 02 :41pm CUSTOMER TO COMPLETE 3903655 BRUSH BIN WIRE FINE 1.00 10,49 10,49 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 10.49 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00% Tax 0100 indicated below and understands Total 10.49 engaged in the business of agricultural production of and agrees with the General TSC Card 10.49 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Acct :Y2t2S*S3tYiY5874 resale and /or uses the farm machinery, equipment or the applicable statement of the Auth #:008605 Ref #:0813412035 respective state printed on the other agricultural production items purchased free of PO truckt l reverse side of this form. tax, as defined by state law, and as indicated 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 b State IaW Should SUCK dS be Used Or CO n SU med Irf y�/p Buyer acknowiedses the receipt of a comP�e (Exceptions: Georgia, New York Kentucky goods COMPLETE REVERSE SIDE) state 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) EYYSiiiiiiYYaaYYYYYaYYYaiiiiai Farm Machinery/Repair Parts Government Agency (Entity# tiiitYYEYitEEEYYY iEY882YiitiYEEEYEYYi Livestock In estibles or In ectibles F1 1 1 Exempt Organization (Entity# Call 800 968-0734 within 7 days to E) Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a monthly drawins for a chance to win a Consumed in Production (KS) Resale (Sales Tax Permit $2500 shoppins spree. Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY, Ends 9130109. Other: YYYEYYiiiYEYYiiEYYEEYYifYiYEEYYYYYYEi CUSTOM IGNATURE:(REQUIRED) MGR. APPROVAL USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EX H. DATE 71 1 1 1 ITEM NUMBER DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC B USINESS ACCOUNT �1�R® PAYMENTS TO: 1. TRACTOR SUPPLY COMPANY CWT co P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf field, IN 46074 6035 301 317) 867 -3505 NAME CARMEL STREET DEFT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000179 2 929492 05/08/2009 02 :40Pm CUSTOMER TO COMPLETE 0476308 BOOSTER 20FT 46AU CA 1100 49.99 49.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT Government Asencies The undersigned certifies The undersigned party certifies their exemption from 0476308 BOOSTER 20FT 4GAU CA compliance with the agricultural payment of sales and use tax on tangible personal 1100 49.99 49.99 NT sales tax exemption law of the state property as indicated below and /or purchaser is Government Asencies indicated below and understands engaged in the business of agricultural production of and agrees with the Genera/ Subtotal 99.98 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00S Tax 0.00 the applicable statement of the Total 99.98 respective state printed on the other agricultural production items purchased free of TSC Card 99.98 reverse side of this form. tax, as defined by state law, and as indicated below. Acct 0 t s $5874 AathO:008392 Ref0:0813400005 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they PO truck 11 understand the may be liable for p ayment of all taxes STATE: y y p y Chance O,Op (REQUIRED) due on the purchase price for the goods as allowed by Cash Back (Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Buyer acknowledses the receipt Of a CQNPIe F7 Resale Under penalty of perjury, signee swears th Government information on this statement is true and correct 1p copy of this sales slip and the Purchase o Exempt organization every material manner. A willfully false representation h Agricultural Production of exemption will cause the purchaser to be subject to the described merchandise shal be in E] Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreement Livestock Production Floriculture /Aquaculture Production law. Other: Sisnature: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity NC: only DOT and US Government are exempt E2$$ ffiE $$SELE12ii$i$$t$$3tEEttt$E$$$8i Fertilizer /Agrichemicals Consumed in Production (KS) Resale (Sales Tax Permit 1 Call 800 968-0734 within 7 days to Ingredient or Component Parts (KS) complete a survey and be entered in a monthly drawins for a chance to win a other: 82500 shoppins spree. (Awarded as Gift Card) NO PURCHASE CUS7 (REQUIRED MGR. APPROVAL i X USE i SHA DED ONLY O' CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE DESCRIPTION Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS TO:' T��® TRACTOR SUPPLY COMPANY r supny co P.O. Box 9020 Tractor Supply Company Des Moines, IA 50368 -9020 18160 U .S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield, IN 46074 6035 301# (317) B67 -3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 431 431000172 2 929101 05/07/2009 10:05am CUSTOMER TO COMPLETE 4433433 GW POST HOLE DIGGER 1.00 69.99 69.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT Government Agencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 69.99 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 69.99 engaged in the business of agricultural production of and agrees with the General TSC Card 69.99 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and Acct *$3122 ###*5874 resale and /or uses the farm machinery, equipment or the applicable statement of the Auth#:007360 Ref# :0709044520 respective state printed on the other agricultural production items purchased free of pp trk 57 reverse side of this form. tax, as defined by state law, and as indicated below. Chanse 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 Buyer acknowledses the receipt of a Mon (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed In COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Corr of this Sales slip and the Purchase 0 f PURCHASER IS ENGAGED IN: (REQUIRED) the d e s cribed merchandise shall be I Resale Under penalty of perjury, signee swears the Government information on this statement is true and correct in accordance with the Cardholder Asreement. Exempt organization every material manner. A willfully false representation LJ Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and/or other provisions as allowed under state Sisna tune Livestock Production F 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 Call 800- 968 -0734 within 7 days to Fertilizer /Ag rich emicals NC. only DOT and US Government are exempt complete a survey and be entered in a monthly drawins for a chance to win a Consumed in Production (KS) Resale (Sales Tax Permit $2500 shorrins spree, Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY. Ends 9130109. Other: CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL X USE AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE e DESCRIPTIO Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL am m REMIT TSC BUSINESS ACCOUNT PAY MENTS TO: TRACTOR SUPPLY COMPANY P.O. Box 9020 Tractor SUPPIY Co mpany Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westfield, IN 46074 6035 301 317) 867-3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE zip PHONE 431 431000179 2 930924 05/13/2009 11:36am CUSTOMER TO COMPLETE 3010575 RATCHET 2X27 2PK CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT- 2.00 24.99 49 .98 NT (WAS 29.99). The undersigned certifies The undersigned party certifies their exemption from Government Asencies compliance with the agricultural payment of sales and use tax on tangible personal 1069332 002HTS TOWING MAGNET sales tax exemption law of the state property as indicated below and /or purchaser is 1.00 52.99 52.99 NT indicated below and understands engaged in the business of agricultural production of Government Asencies and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 0116479 FLOUR JACK 2T Exemption Statement at right and resale and /or uses the farm machinery, equipment or 1.00 29.99 29.99 NT the applicable statement of the other agricultural production items purchased free of Government Asencies respective state printed on the tax, as defined by state law, and as indicated below. reverse side of this form. Subtotal 132.96 The under art further certifies the 7.00% Tax 0.00 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 Total 132,96 (REQUIRED) due on the purchase price for the goods as allowed by TSC Card 132.96 (Exceptions: Georgia, New York Kentucky state law Should such goods be used Or Consumed In Acct 0 a a a'$ a a a s 4803 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Autho :013613 Reft:1310355217 PURCHASER IS ENGAGED IN: (REQUIRED) PO a shop Resale Under penalty of perjury, signee swears the Chanse 0.00 Government information on this statement is true and correct in Cash Back Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will. cause the purchaser-to -be subject to Buyer acknowledses the receipt of a comple Dairy Production penalty and /or other provisions as allowed under stat Livestock Production copy of this sales slip and the Purchase o Floriculture /Acluaculture Production law' f Other: the described merchandise shall be in ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) accordance with the Cardholder Asreement Farm Machinery/Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity Sisnature: Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Consumed in Production (KS) Resale (Sales Tax Permit Ingredient or Component Parts (KS) Other: YaEatEEYYEiifEEi $$i$$$$aYYi$$$$$aaYtY sE$$$ aaa $YYasa$aEtaaaaaastatYaYYEY:aa Call 800 968 -0734 within 7 days to C S MER IGNATURE: (REQUIRED)� MGR. APPROVAL V X 0 0 WtIV A CHECK :VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE L] �Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT IV TRAiCTOR® PAYMENTS TO: TRACTOR SUPPLY COMPANY Su"LY CO P.O. Box 9020 Des Moines, IA 50368- 9020 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number fir! 6035 301 (3;7) E6 f t NAME CARMEL 51PEET DEPT 3400 W 131ST 51 ADbRESS W E SIFIEI -D (517) 7;5 2001 CITY STATE ZIP PHONE 1:. 4310001 r'1 2 "`f 1 u U4% 0P 23i2C ;Z 18101 CUSTOMER TO COMPLETE 35V757z ;Ci- 11t.:1E1 BItTER CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. Go t7. ic d r Gc.iternri�nt f:..ci,c The undersigned certifies The undersigned party certifies their exemption from 35` 'i9537 RATCHCT 1 i i +fir! compliance with the agricultural payment of sales and use tax on tangible personal 1 .00 Lt sales tax exemption law of the state property as indicated below and /or purchaser is Gave t 03e• +c c_ indicated below and understands engaged in the business of agricultural production of and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Sub tUtai Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7,0i; T6x the applicable statement of the other agricultural production items purchased free of l i5.SL respective state printed on the tax, as defined by state law, and as indicated below. TSC Cza1•d 9'_:. Yo reverse side of this form. ACCt #;YHt$$7$$tSi3 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they rwi h'- 2 J1'J111412 STATE: understand they may be liable for payment of all taxes PO 4 :042309 (REQUIRED) due on the purchase price for the goods as allowed by C'n: +se n, c (Exceptions: Georgia, New York a Kentucky state law should such goods be used or consumed in C«sh u'OL' COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee swears theLd Government information on this statement is true and correct in cony of this �ialv5 51ir ,,,id Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to itue drjl ttiCd Dairy Production penalty and /or other provisions as allowed under state accord• -tiLe will; the Livestock Production F Floriculture /Aquaculture Production law' Other: Si �rtdttdP� ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock Iniestibles or Injectibles Exempt Organization (Entity Fertilizer /Agrichemicals NC: only DOT and US Government are exempt 22 212 Y i s 3 Y£ a a t s i 9?£ ti 3 8 r 's t :i Consumed in Production (KS) Resale(SalesTaxPermit# $u;�Y�3 'si3oe:33 >33338'i; _33:;r,s;ti.i? Call CC, 0734 within 7 Joy:, u Ingredient or Co onent Parts (KS) coidi> le to a survey and be en i -red %,i f Other: nionftily drawins for a C1 ,o win $2500 shoepiw.; a°rQC, (i): arded a5 Gift C_ir„) NO PlJ1;C;M7,E CUS70ME S AT E: (REQUIRED) MGR. APPROVAL X USE SHADED AREA ONLY CASH CHECK VISA WC DISCOVER TSC CHARGE ACCODNT NO. CHG. EXCH. DATE [J arm No 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT' PAYMENTS TO:' TRACTOR SUPPLY COMPANY aff"Ly P.O. Box 9020 Tractor 31 Nort Des Moines, IA 50368 -9020 1816 1816 0 U.S. field, IN 4 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317)' 867 -3505 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST ST WESTFIELD IN 460748267 ADDRESS (317) 733 -2001 CITY STATE ZIP PHONE 431 786000104 2 928383 05/04/2009 03:03pm CUSTOMER TO COMPLETE 1099531 TBX SPEC ALUM 60IN I 1.00 259.99 259.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Agencies The undersigned certifies The undersigned party certifies their exemption from Subtotal 259.99 compliance with the agricultural payment of sales and use tax on tangible personal 7.00% Tax 0100 sales tax exemption law of the state property as indicated below and /or purchaser is Total indicated below and understands engaged in the business of agricultural p roduction 259, 99 on o and agrees with the General g p TSC Card 259,99 Exemption Statement a right and food or fiber, horticulture, aquaculture of floriculture for Acct EEEsEEEESSEE6062 the applicable statement of the resale and /or uses the farm machinery, equipment or Auth #:004668 Ref #:0414033346 respective state printed on the other agricultural production items purchased free of PO 0:050409 reverse side of this form. tax, as defined by state law, and as indicated below. Change 0.00 The undersigned art further certifies the Cash Back PRODUCT IS TO BE USED IN THE FOLLOWING 9 party Y STATE: understand they may be liable for payment of all taxes Buyer acknowledges the receipt of a cD�e (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 cOPY Of this sales g1iP and the Purchase 0 COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. f PURCHASER IS ENGAGED IN: (REQUIRED) the described merchandise shall be in Resale Under penalty of perjury, signee swears the accordance with the Cardholder Agreement, 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 Floriculture /Aquaculture Production law' Other: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity EEEEEE2EEYifi2siiiiEEYEEEEEEiESiEEYE2 Call 800 968 -0734 within 7 days to Livestock Injestibles or Injectibles Exempt Organization (Entity# complete a survey and be entered in a Fertilizer /Agrichemicals NC: only DOT and US Government are exempt monthly drawing for a chance to win a Consumed in Production (KS) Resale (Sales Tax Permit $2500 shopping spree, Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE OR SURVEY NECESSARY. Ends 9130109, Other: EEEESiEESEEEYEEEEEEiESES 2sEESSEEEESYE CU 70 RS RE:(RE I D� MGR. APPROVAL l X u USE SHADED AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE I I I ITEM NUMBER NON DESCRIPTION UNIT PRICE TAX i Form No. 99 -00401 (12/05) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT 701t PAYMENTS. ONLY TO: TRACTOR SUPPLY COMPANY VSUPnYCO P.O. Box 689020 T; ac f or �i t'P 1Y Co;ap�tov Des Moines, IA 50368 2375 Fast F'leasalti 3t, TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number IN 46040 6035 301 317) 776 1863 NAME CARMEL STREET DEFT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 624 62•1400481 2 1121154 44/23/2009 43:11x6; CUSTOMER TO COMPLETE 3599537 RATCHET DINDER 1 /4IN CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 Government4Asencie= 47,99 NT The undersigned certifies The undersigned party certifies their exemption from 35995.;; RATCHET BINDER 114IN compliance with the agricultural 1.00 G -47, 2,2 7.99 HT sales tax exemption law of the state payment of sales and use tax on tangible personal indicated below and understands property as indicated below and /or purchaser is Governtnernt (o eocies 3543861 )10JK I ;IN CLITt/IS SL and en agrees with the General gaged in the business of agricultural production of food or fiber, horticulture, aquaculture of floriculture for 8' 40 C' 8.79 70.32 .4T Exemption Statement right and resale and /or uses the farm machinery, equipment or Govaj Asenci.es the applicable statement nt the other agricultural production items free respective state printed on n the ems purcase ree o Subtotal. 166.34 reverse side of this form. tax, as defined by state law, and as indicated below. 1.00: Tax 0,40 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Tote.l 166,30 understand the may be liable for p ayment of all taxes TSC Card 166,30 STATE: (REQUIRED) due on the purchase price for the goods as allowed by ACC ttE t t i t i i s t t t t #6,120 L Exceptions: Georgia, New York &Kentucky state law should such goods be used or consumed in Auth :023856 rie'Fo:2314, 74953 :OMPLETE REVERSE SIDE) Pa 8 O ?346 a taxable manner as defined by state laws. URCHASER IS ENGAGED IN: (REQUIRED) Chdn3e Resale Under penalty of perjury, signee swears the Cash Back Government information on this statement is true and correct in Buyer ackno- ledges the receiP t or a conwle Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to copy of t1, k.5 sales slip and the Purchase o Dairy Production penalty and /or other provisions as allowed under state Livestock Production law. th-- de3cribed tnerch shall be in Floriculture /Aquaculture Production acco da.t _e with tilt: Civdholdee Asreltititnt. Other: AS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Sispzl'ture: Livestock Injestibles or Injectibles Exempt Organization (Entity NC: only DOT and US Government are exempt Feribzei)Agrichemicals Resale (Sales Tax Permit Consumed in Production( ingredient ofComponen arts (KS) Call 1300 °Fr66 0734 wictin 7 days co canlpte a aurvvy and be entered in a Other: MGR. APPROVAL bMER S AE: EQUIRED) r r 1 DATE 0 CHG. EXCH. VILA MIC DISCOVER TSC CHARGE ACCOUNT N0. UNIT PRICE 'R4J Ct -IECK D p j D r OR�G�N C� REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY SV�'pI,YCO P.O. Box 689020 Tractor Su pply Company Des Moines, IA 50368 2375 East Pleasant St TSC TEAM MEMBER TO COMPLETE Noblesville IN 46060 Please include 16 Digit Account Number (317) 776 -1883 6035 301 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733-2001 CITY STATE ZIP PHONE 624 624000070 1 1125721 05/01/2009 02:24pm CUSTOMER TO COMPLETE 3020520 STRAP RATCHET 1x10 1 1.00 14,99 14,99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Res Price 19.99 The undersigned certifies The undersigned party certifies their exemption from Government Agencies compliance with the agricultural 3018272 ANCHOR FLIP 5000LB payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is 1 00 3.29 3.29 NT Government Agencies indicated below and understands engaged in the business of agricultural production of and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 3018272 ANCHOR FLIP 5000LB Exemption Statement at right and 1.00 3.29 3.29 NT the appli able It nt of the resale and /or uses the farm machinery, equipment or Government Agencies c st eme respective state rinted on the other agricultural production items purchased free of 3018109 STRAP RATCHET 2X27 1 reverse side of thi form. tax, as defined by state law, and as indicated below. 1.00 14.99 14.99 NT The under art further certifies the Res. Price: 17.99 PRODUCT IS S INTHEFOLLOWING g P y y Government Agencies STATE: understand they may be liable for payment of all taxes 3018109 STRAP RATCHET 2X27 1 (REQUIRED) due on the purchase price for the goods as allowed by 1.00 14.99 14.99 NT (Exceptions: eorgia New York a Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Res Price 17.99 PURCHASER IS ENGAGED IN: (REQUIRED) Government Agencies 0116487 BOTTLE JACK 20T Resale Under. penalty of perjury, signee swears the 1.00 ACK 2 34.88 NT M Government information on this statement is true and correct in Exempt organization every material manner. A willfully false representation Government Agencies Agricultural Production of exemption will cause the purchaser to be subject to Dairy Production penalty and /or other p rovisions as allowed under state Subtotal 86.43 F1 Livestock Production p y p 7.00% Tax 0.00 Floriculture /Acluacullure Production law. Total. 86 .43 Other: TSC Card 86.43 Acct #:ssis3tsssts34803 ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Au th# 001972 Ref 1: 0113244204 Farm Machinery/Repair Parts Government Agency (Entity PO shop Livestock Injestibles or Injectibles Exempt Organization (Entity Change 0.00 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt Cash Back Consumed in Production (KS) Resale (Sales Tax Permit Buyer acknowledges the receipt of a comp le Ingredient or Component Parts (KS) to 1 copy of this sales 9 and the purchase o er: f the described merchandise shall be in accordance with the Cardholder Agreement. MR IG ATJE: (REQUIRED) MGR. APPROVAL aa� X IN USE SHADED AREA ONLY WHEN REGISTER IS CA C ECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE 1 L1 ITEM NUMBER DESCfIIPTIO mNo. 99.00401 (12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT TRA�C�R® PAYMENTS TO: TRACTOR SUPPLY COMPANY i7 su"LYCOM P.O. Box 9020 Tractor U.S. Supp 3 C Des Moines, IA 50368 -9020 18160 U.S. 31 North TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Westf ield, IN 46074 6035 301 317) 867 -3505 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 Cr:Y STATE ZIP PHONE 431 786000104 Z 926862 04/29/2009 02:53Pm CUSTOMER TO COMPLETE 3958236 FUEL NOZZLE AUTOM UN CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 Go a 59,99 59.99 NT Government Asencies The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtotal 59.99 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00% Tax 0.00 indicated below and understands engaged in the business of agricultural production of Total 59,99 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card 59.99 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acc14:Sttt%ttti1tt6021 the applicable statement of the other agricultural production items purchased free of AUth #:OZ9018 Ref :Z913525799 respective state printed on the tax, as defined by state law, and as indicated below. PO #:042909 reverse side of this form. Chanse 0.00 PRODUCTUISITP BE USED INT FOLLOWING The undersigned party further certifies they Cash Back STATE: understand they may be liable for payment of all taxes (R o IR I due on the purchase price for the goods as allowed by Buyer acknowledse5 the receipt of a comPle (Exceptions: Georgia, New York Kentucky state law Should such goods be used or consumed i hed 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 ,X Government information on this statement is true and correct in accordance with the Cardholder Asreemen t 0 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: (REQUIRED) Farm Machinery/Repair Parts �GovernmentAgency(Entity# BtiEiiitiEEEtEEtHifiYHYYiiiBiEiHEi2E2 Livestock Injestibles or Injectibles Exempt Organization (Entity Call 800 -968 -0734 within 7 days to Fertilizer /Agrichemicals NC: only DOT and US Government are exempt complete a survey and be entered in a Consumed in Production (KS) Resale (Sales Tax Permit monthly drawins for a chance to win a $2500 shoPPins spree. Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE Other: OR SURVEY NECESSARY. Ends 9/30/09, HE88I88HtHtHYEYtEEtEEHHYitBtEHEtiHYEE CUST MER SIGNATURE: IRED) MGR. APPROVAL r X USE AREA ONLY CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE DESCRIPTIO b6 F6-�7" _'0401(12/05) CUSTOMER ORIGINAL 1 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)) 06/01/09 $465.23 06/01/09 $516.88 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer r VOUCHER NO. WARR NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $982.11 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #(TITLE AMOUNT Board Members 2201 42- 380.00 $465.23 1 hereby certify that the attached invoice(s), or .2201 42- 370.00 $516.88 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 i �F iday J ne 05 2 09 l.. S��e�t r Title Cost distribution ledger classification if claim paid motor vehicle highway fund