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179440 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1 ONE CIVIC SQUARE TRACTOR SUPPLY CO CARMEL, INDIANA 46032 PO BOX 689020 CHECK AMOUNT: $603.57 DES MOINES IA 50368 -9020 CHECK NUMBER: 179440 CHECK DATE: 11/11/2009 DEPARTMENT ACCO PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION 2201 4237000 STREET 66.26 6035301200050860 2201 4356001 STREET 537.31 6035301200050860 page 1 of 4 TX 7 D 130000000 TRACTOR ®YVPiYi pp VV BUSINESS ACCOUNT 0000440 —4 Previous Balance 63.79 Closing Date 10/20/09 Payments 131.39 Next Closing Date 11/18/09 CARMEL STREET DEPT Credits 0.00 Payment Due Date 11/14/09 CINDY Purchases 603. 57 3400 W 131 ST ST Debits 0.00 Current Due 535.97 WESTFIELD, IN 46074 -8267 FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250 Late Fees 0.00 Minimum Payment Due 535.97 Credit Available 4,714 New Balance 535.97 CURRENT ACTIVITY Tr.... tlon Lflcat onf J quint C1af#eL)escr'`tleit z SEP 29 GOODS AND SERVICES WESTFIELD IN 24,99 OCT 13 GOODS AND SERVICES WESTFIELD IN 35.98 -Sio TOTAL 6035301200074803 $60.97 OCT 14 GOODS AND SERVICES WESTFIELD IN 5.29 -S"O TOTAL 6035301200074811 $5.29 OCT 9 GOODS AND SERVICES NOBLESVILLE IN 189.98- OCT 19 GOODS AND SERVICES NOBLESVILLE IN 107.36- TOTAL 6035301200074829 $297.34 FINANCE CHARGE SUMMARY Current Billing Period Previous Billing Period Balance Daily Days in ANNUAL Balance Daly Days in ANNUAL Suhject to Periodic Billing PERCENTAGE SutOject to Periodic Billrg PERCENTAGE Finance Charge Rate Period RATE Finance Charge Rate Period RATE REGULAR REVOLVE CREDIT PLAN 0.00 .00000 32 0.00 0.00 .00000 30 0.00 5 10 "1. 3 4 Thi2 &r,9u0j 1�5ued by Qgi¢aQS ja2gth Dakot N.A. CUSTOMER SERVICE 1-800-559-8232 FAX NUMBER 1- 801 779 -7425 Notify Us in Case of Errors or Questions About Your Bill Copy Fee: On any matter unrelated to a billing error or disputed purchase, we charge a $5.00 fee for each duplicate statement for a billing period that If you think your billing statement is wrong, or if you need more information is more than 3 months prior to your request. We add this fee to your regular about a transaction on your billing statement, write to us (on a separate revolve credit plan balance. sheet) as soon as possible at the billing error address on the front of your statement. We must hear from you in writing no later than 60 days after we Payment Options Other Than Regular Mail: sent you the first statement on which the error or problem appeared. In your letter, give us the following information: Pay by Phone. You may make your payment by phone by using the Pay by Phone Service. You will be charged $14.95 to use this payment service. Your name and account number. Call by 5 p.m. Eastern time to have your payment credited as of that day. The dollar amount of the suspected error. If you call after that time, your payment will be credited as of the next day. Describe the error and explain, if you can, why you believe there is an We may process your payment electronically upon verification of your error. If you need more information, describe the item you are unsure identity. about. Send payment by courier or express mail to the Express Payments address: Customer Service Center, Dept, CCS 8725 W. Sahara Blvd., Las Important Payment Instructions Vegas, NV 89117. Payment must be received in proper form, at the proper address, by 5 p.m. Pacific time in order to be credited as of that day. All Crediting Payments: Payment must be received in proper form at our payments received in proper form, at the proper address, after that time processing facility by 5 p.m. local time there to be credited as of that day. A will be credited as of the next day. payment received at the processing facility in proper form after that time will be credited as of the next day. Please allow 5-7 days for payments by Report a Lost or Stolen Card Immediately: Customer Service is available regular mail to reach us. There may be a delay of up to 5 days in crediting a 24 hours a day, 7 days a week. payment sent by mail if it is not in proper form or is addressed to a location other than the address listed on the return envelope or on the front of the Your account is issued by Citibank (South Dakota), N.A. payment coupon, or, for courier or express mail payments, to the Express Payments Address set forth below. Proper Form: For a payment sent by mail or courier to be in proper form, you must: Enclose a valid check or money order. No cash, gift cards, or foreign currency please. Include your name and account number on the front of your check or money order. Tractor Supply Co. Full Balance S902TV 10/06 902TV5741006 PCT page 2 of 4 TX 7 D 130000000 =ro TRACTOR' �SUFFLYCS BUSINESS ACCOUNT 0000441 CURRENT ACTIVITY s 0 nt OCT 8 GOODS AND SERVICES NOBLESVILLE IN 69.99` TOTAL 6035301202895916 $69.99 OCT 8 GOODS AND SERVICES NOBLESVILLE IN 129.99, 51eD,oi TOTAL 6035301202895981 $129.99 OCT 9 GOODS AND SERVICES WESTFIELD IN 39.99 51x0 U� TOTAL 6035301202896039 $39.99 PAYMENTS, CREDITS, FEES, and ADJUSTMENTS OCT 8 PAYMENT REF P9194008S09Y8XO24 131.39 This account is subject to the Alternate Balance Subject to Finance Charge Calculation Method. See back for details. Remit To: Bill To: Page 3 or 4 -r TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 DEPT.30- 1200050860 JEFF STEWART 19SUPPLYC0- PO BOX 68907,0 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000442 >o Payment Due Date: 11/14/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN SHIP To: INVOICE: SHIP TO: INVOICE: 431000967098010 431000970371010 Purchase Order: Purchase Order: SHOP SHOP AMOUNT DUE: 24.99 AMOUNT DUE: 35.98 Stare: 574000431 INVOICE DATE: 09/29 /09 Store: 574000431 INVOICE DATE: 10/13109 SSR 121N RECEIVER TUBE 1890995 1.00 24.99 24.99 ROLLER CHAIN 60 LOFT 1150078 1.00 31.99 31.99 LINK CONN 60 1151074 1.00 3.99 3.99 SUBTOTAL 24.99 TAN 0.00 SUBTOTAL 15.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 24.99 TOTAL 35.98 SHIP TO: INVOICE: SHIP TO: INVOICE: 431000970603010 624001201583010 Purchase Order: Purchase Order: 101409 85 AMOUNT DUE: 5.29 AMOUNT DUE: 189.98 Store: 574000431 INVOICE DATE: 10/14/09 Store: 574000624 INVOICE. DATE: 10109 109 LINK OFFSET 60H 1152088 1.00 5.29 5.29 JACKET CRHT ARCTIC 48 6310160 1.00 89.99 89 -99 BIB CRHT ARCTIC 46X30 6409804 1.00 99.99 99.99 SUBTOTAL 5.29 TAX 0.00 SUBTOTAL 189.98 SHIPPING 0.00 TAX 0.00 SHIPPING 0.00 TOTAL 5.29 TOTAL 189.98 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425 Remit To: Bill To: Page 4 or 4 TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860 T DEPT.30 1200050860 BOYD PIERCY 10SULYCo PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT DES MOINES IA 50368 -9020 0000443 Payment Due Date: 11114/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN s SHIP To: INVOICE: SHIP TO: INVOICE: 624001206017010 624001201169010 Purchase Order: Purchase Order: 101909 RANDY AMOUNT DUE: 107.36 AMOUNT DUE: 69.99 Store: 574000624 INVOICE DATE: 10/19/09 Stara: 574000624 INVOICE DATE: 10108 /09 SPECIAL ORDER PAYMENT 624052954 1.00 1.07.36 107.36 SHOE NODES 8M LTHR BN J 7095802 1.00 69.99 69.99 SUBTOTAL 107.36 SUBTOTAL 69.99 TAN 0.00 TAX 0.00 SHIPPING 0.00 SHIPPING 0.00 TOTAL 107.36 TOTAL 69.99 SHIP TO: INVOICE: SHIP TO: INVOICE: 624001201170010 431000969278010 Purchase Order: Purchase Order: JEFF PATCH AMOUNT DUE: 129.99 AMOUNT DUE: 39.99 Store: 574000624 INVOICE DATE: 10/08 109 Store: 574000431 INVOICE DATE: 10/09/09 BOOT 13M GTX DS WEL TAN 7424873 1.00 129.99 129.99 BOOT 5 BUCKEL BLACK 14 6356394 1.00 39.99 39.99 SUBTOTAL 129.99 SUBTOTAL 39.99 TAX 0.00 TAX 0.00 SHIPPING 0100 SHIPPING 0.00 TOTAL 129.99 TOTAL 39.99 Please Direct Inquiries to: Phone: 800 -559 -8232 Fax: 801 779 -7425 REMITTSC BUSINESS ACCOUNT PAYMENTS ONLY TO: TRACTOR SUPPLY 'V51 P.O. Box 689020 Tractor Supply Company Des Moines, IA 50368 2375 East Pleasant St, TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville. IN 46060 6035 301# 317) 776 -1883 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 624 624000103 2 1201169 10/08/2009 02:18Pm CUSTOMER TO COMPLETE 70 SHOE NODES 8M LTHR 8 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1 Re 8 69.99 69.99 NT Res. Price: 84,99 The undersigned certifies The undersigned party certifies their exemption from Government Asenties compliance with the agricultural payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser is Subtotal 6939 indicated below and understands engaged in the business of agricultural production of 7.00% Tax 0.00 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Total 69.99 Exemption Statement at right and TSC Card 69,99 the applicable statement of the resale and /or uses the farm machinery, equipment or pp other agricultural production items purchased free of Acct :E2i2itssssii5916 respective state printed on the tax, as defined by state law, and as indicated below. Autho:008702 Ref* 08131.75370 reverse side of this form. PO a: randy PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Change 0.00 STATE: understand they may be liable for payment of all taxes Cash Back .(REQUIRED) due on the purchase price for the goads as allowed by (Exceptions: Georgia, New York &Kentucky state law Should such goods be used or consumed in Buyer acknowledses the receipt of a comPle_ COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. t PURCHASER IS ENGAGED IN: (REQUIRED) copy of this sales slip and the purchase o Resale Under penalty of perjury, signee swears thEF Government information on this statement is true and correct in the described merchandise shall be in Exemptorganization every material manner. A willfully false representation accordance with the Cardholder Agreement. 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 Signature: Floriculture /Aquaculture Production law' Other: ITEMS PURCHASED.WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity YYEEYYYYiEiEtiiEiEtitYtYiiiEitiiiEi2i Livestock lniestiblesorin iectibles Exempt Organization (Entity E3iE2EEEEE #EE3YEYEEEEEEtEYYYiEEYEYiii Fertilizer /Agrichemicals NC. only DOT and US Government are exempt Call 1300 968 0734 within 7 days t0 Consumed in Production (KS) Resale (Sales Tax Permit complete a survey and be entered in a monthly drawing for a chance to win a Ingredient or Component Parts (KS) $2500 shoppins spree. (Awarded as Gift Card) NO PURCHASE Other: OR SURVEY NECESSARY. Ends 9/30/10. EiEEEEEEEEEEEEEYYiiEEEEEEEEti #Y #EiYYi CUSTOMER NATURE: (REQUIRED) MGR. APPROVAL iG J X USE SHADEDAREA ONLY CASH CHECK VISA M/C QESCOVER TSC CNARGE ACCOUNT NQ CNG: EXGH: DATE D ESC R IPTION ITEMINUMBER TAX Form No. e9-00401 (12/08) CUSTOMER ORIGINAL 7 REMIT TSC BUSINESS ACCOUNT TRACTOR PAYMENTS ONLY TO: 17 TRACTOR SUPPLY COMPANY P.O. Box 689020 Tractor 54-trply Cofivny SU"LYC2 a Des Moines, IA 50368 '16160 U.S, 31 worth We5tfield,IN 4607 TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317) 067• -3505 (6035 301 L I NAME C �RMLL STRLET DF-P.1 SAOO W 131ST ST WESTFIELD IN 44'0748267 ADDRESS (31e) 73S -2001 CITY STATE ZIP PHONE 4:31 431000105 2 969278 10/09"2009 10:523q; CUSTOMER TO COMPLETE 6356334 BOOT 15 BlYKEL BLACK 1 39,99 N1 1.00 R 39. V9 CERTIFICATE OF EXEMPTION:-. GENERAL EXEMPTION STATEMENT- Government Menries �The u ncleirsigned certifies The undersigned party certifies their exemption from Subtotal compliance with the agricultural payment of sales and use tax on tangible personal 7.00% TaA 0.00 on law of the state property as indicated below and/or purchaser is Total 39,99 indicated b sales tax exemption and understands engaged in the business of agricultural production of and a YSc card 39,91) agrees with the General Exemption cc ton Statement at right food or fiber horticulture aquaculture of floriculture for At*:s1%9t*t3%1t1603? and the applicable statement of the resale and/or uses the farm machinery, equipment or Au t h t: 009231 Ref 0909 L respective stale printed on the other agricultural production items purchased free of PO t:eatch tax, as defined by state law, and as indicated below. Change 0,00 reverse side of this form. Cash Back 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 ackriowledses the receipt of a (REQUIRED) due on the purchase price for the goods as allowed by, d (Exceptions: Gec'gia, New York Kentucky state law should such goods be used or consumed in copy of this sales 51ir and the PUFCh",15e COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. f PURCHASER IS ENGAGED IN:(REQUIRED) the described nterchandise shall be in Resale Under penalty of perjury, signee swears the accordance with the Cardholder Asreeaie.it, Government information on this statement 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 Sisnature: Dairy Production penalty and/or other provisions as allowed under state Livestock Production El law. FloricultureiAquaculture Production Other: 'ITEMS PURCHASED WILL BE USED FOR:(REQUIRED) Farm Machinery/Repair Parts. Government Agency (Entity Call 900 within 7 iJaY5 to 0. Livestock Iniestibles or Injectibles Exempt Organization.(Entity complete a survey and be entered in a F Fertilizer/Agirldhemicals NC: only DOT and US Government are exempt aionth1y.dirawins for a chance to win a Consumed in Production (KS) Resale (Sales Tax Permit shoppit)5 spree, .(Awar di!d. Gift Card) NO PURCHASE F1 ingredient or Component Parts (KS) OR SURVr Ends 9/30/10, E Y NECESSARY., E] Other: CUSTOM R SIGNATURE IRFD) GR.APPROVA r USE SHADED AREA ONLY WHIEN-REGISTER IS INOPERATIVE. CASH CHECK, A DISC OVER TSC CHARGE ACCOUNT NO. -CHG. EXCH.. PATE L] Ll J QF Ll DESCRIPTION. Form No. 99-00401 (12JOB) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT R�CT�OR® PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY igsi Vy co P.O. Box 689020 Des Moines, IA 50368 Tractor t PPeY an 2375 East Pleasant 5t. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesvil le. IN 46060 6035 301 317) 776 -1003 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 46 0748267 (317) 733 -2001 CITY STATE ZIP PHONE 624 624000103 2 1201170 10/08 /2009 02:20Pm CUSTOMER TO COMPLETE 7424873 BOOT 13N GTX DS WEL CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1.00 8 129,99 129,99 Ni 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 129,99 sales tax exemption law of the state property as indicated below and /or purchaser is 7.00%c Tax 0100 indicated below and understands engaged in the business of agricultural production of Total 12939 and agrees with the General food or fiber, horticulture, aquaculture of floriculture for TSC Card 129,99 Exemption Statement at right and resale and /or uses the farm machinery, equipment or Acct #:1tt#t##1tt ;x5981 the applicable statement of the other agricultural production items purchased free of Auth +:0624 Reft: respective state printed on the tax, as defined by state law, and as indicated below. PO #:,ieff reverse side of this form. 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 ac knowledses the receipt of a comp l e (Exceptions: Georgia, New York Kentucky- state law should such goods be used Or consumed Irf d COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. copy of this sales slip and the Purchase o PURCHASER IS ENGAGED IN: (REQUIRED) I 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 FOF:(REQUIRED) Farm Machinery /Repair Parts Government Agency (Entity Livestock Injestibles or Injectibles Exempt Organization (Entity 1 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(SalesTaxPermit# monthly drawins for a chance to win a Consumed in Production (KS) $2500 shoppins spree, Ingredient or Component Parts (KS) (Awarded as Gift Card) NO PURCHASE F Other: OR SURVEY NECESSARY. Ends 9/30/10, CUSTOMER SIG TURE: (REQUIRED) MGR. APPROVAL X SHA USE AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK ,VISA M!C DISCOVER TSC CHARGE ACCOUNT NO. GHG.' EXCH:. DATE DESCRIPTION UNIT PRICE- ITEM NUMBER Farm No. 99 -00401 (12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT. PAYMENTS ONLY TO: I ,a TRACTOR TRACTOR SUPPLY COMPANY SUI%YCO P.O. Box 689020 Tra ctor Sur rly Cjmihaw Des Moines, IA 50368 18 IJ.G-. 31 Warth TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number WQst 46V4 (317) 867 SuO.ti (6035 301 NAME CARMEL SIRELI DEF"( 3400 Q 131ST ST ADDRESS W ,I EqT FTLr) IN 46074826? "?33_2001 CITY STATE ZIP PHONE 4, t 7860OW04 2 9(060 CUSTOMER TO COMPLETE 1 LINK OFFSET 6011 mn e 5.29 5,29 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Govvrntuelat A!wnrie5 Vn The undersigned certifies The undersigned party certifies their exemption from compliance with the agricultural payment of sales and use tax on tangible personal Subtrital 5,29 sales tax exemption law of the state lax O.Ou property as indicated below and/or purchaser is Total. S,Z7 indicated below and understands engaged in the business of agricultural productioti of I and agrees with the General food or fiber, horticulture, aquaculture of floriculture for FSC Card 29 Exemption Statement at right and ACC resale and/or uses the farm machinery, equipment or Wvt*w313tss48J1 the applicable statement of the other agricultural production items purchased free of AUih*;014524 RL- 140927,1045 respective state printed on the 1:10 reverse side of this form. tax, as defined by state law, and as indicated below. PRODUCT ISJJO�M USED IN THE FOLLOWNG The undersigned party further certifies ies they Cd-Al Bac�, STATE: understand they may be liable for payment of all taxes the I-Lcetpt of a AREQUIRED) due on the purchase price for thecgoods as allowed by,, (Exceptions: Georgia, New York Kentucky state law should such goods used or consumed in COMPLETE REVERSE SIDS) C Ut Y Of flJ FO L" {'Ira FUrchase 0 1 a taxable manner as defined by state laws.. PURCHASER IS'ENGAGED IN: (REQUIRED) Resale Under penalty of perjury, signee I swears the :.ha ll be in aCLurdance with die CardholC, r A�revnient. ,t_J information on this statement is true and' correct in Ex6nnpt.crganization every material manner. A willfully. false representation M ­A�gricultur'al.Production of e e tion will cause the purchitser to be subject to Dalry:Pr6du;qtion x mp si�m penalty and/or other proVisions'a's!allbvv�d Ej_ U�6�ioc� Production ."I ultu're.Pribduction. law.. F onqu 6�e/Aquac t ITEMS i ,W IE RE US FOR: (REQUIRED) f�A'Ikdcki n'b"ry/ R"epair- P*arts' �,.!E] ,Go'v ernment A&ncy.(Entity #7 C71 I i t I Y "LMY5 110. 7i 2 livestdck or lnje6tibles -,�i 4k ;E]i,,�Exe6pt Organization (Entity #1 overnmeRIV0 r'�" exempt t voy and L ep"i ft'red in 4 -',�,�N only ,DOT and US G overnment wa V't t �l P :1 A (Sa es ax P e r mit i t° f 01c6obsuffiedin P�6d6c1i6n'(KS)-. -_h61 %A ti g 11 I pu.��4 W1 r. J, Ingr ed ien t s 4 4 ;n. 3. rNf 2 CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL USE SHADED AREA ONLY WHEWREGISTER IS INOPERATIVE. CASH CHECK M/C 'DISCOVER TSC CHARGE ACCOUN CHG.. 7 VISA TINO. DATk LJ U L] 1 11 L ITEM NUMBER NON DESCRIPTION UNIT PRICE TAX Form No. 99-00401 (12108) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT RQ PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY Si C2 P.O. Box 689020 Tractor Supply Company Des Moines, IA 50368 2375 East Pleasant St. TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesville, IN 46060 6035 301 317) 776 -1883 NAME CARMEL STREET DEPT 3400 W 131ST ST ADDRESS WESTFIELD IN 460748267 (317) 733 -2001 CITY STATE ZIP PHONE 624 624000091 2 1201583 10/09/2009 02:29pm CUSTOMER TO COMPLETE 6310160 JACKET CRHT ARCTIC 4 CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1.00 89 .99 89.99 NT Government Asencies The undersigned certifies The undersigned party certifies their exemption from 6409804 BIB CRHT ARCTIC 46X3 compliance with the agricultural payment of sales and use tax on tangible personal 1.00 99.99 99.99 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 General Subtotal 189.98 food or fiber, horticulture, aquaculture of floriculture for Exemption Statement at right and resale and /or uses the farm machinery, equipment or 7.00% Tax 0.00 the applicable statement of the Total 189.98 respective state printed on the other agricultural production items purchased free of TSC Card 189,98 reverse side of this form. tax, as defined by state law, and as indicated below. Acct•: x;;; ;:;;:x:;4829 The under art further certifies the Auth4:009111 Re44:0913290293 PRODUCT IS TO BE USED IN THE FOLLOWING g p arty y STATE: understand they may be liable for payment of all taxes PO 4: 095 Change 0.00 (REQUIRED) due on the purchase price for the goods as allowed by (Exceptions: Georgia, New York Kentucky state law should such goods be used or consumed in Cash Back COMPLETE REVERSE SIDE) a.taxable manner as defined by state laws. PURCHASER IS ENGAGED IN: (REQUIRED) Buyer acknowledges the receipt Of a Come le Resale Under penalty of perjury, signee swears the: d Government information on this statement is true and correct in copy of this gales slip and the Purchase o Exempt organization every material manner. A willfully false representatiorf Agricultural Production of exemption will cause the purchaser to be subject to the described merchandise shall be in Dairy Production penalty and /or other provisions as allowed under state accordance with the Cardholder Asreement. Livestock Production Floriculture /Aquaculture Production 11w. Other: Signature: ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Farm Machinery/Repair Parts Government Agency (Entity Livestock lnjestibles or Injectibles Exempt Organization (Entity F1 Fertilizer /Agrichemicals NC: only DOT and US Government are exempt ❑.Resale (Sales Tax Permit E;i iii ;ti;i ;t ;;tittitxttitt ;tit Consumed in Production (KS) 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: '$2500 shopains spree. (Awarded as Gift Card) NO PURCHASE CUSTOMER SIGNAT "11i YRO) MGR. APPROVAL X USE SHADED AREA 1 VV ONLY CASH CHECK VISA M/C DISCOVERSGCHARGE ACCOUNT NO. CHG. EXCH. DATE nn ..1 ITEM DESCRIPTI NUMBER Form No. 99- 0040102/08) CUSTOMER ORIGINAL ORDE SPECIAT 10109/09 0 :5 PM 624 NOBLESVILLE, IN. Page 1 of 1 y SO# 624052954 CUSTOMER CARMEL STREET DEPT SHIP TO SHIP TO STORE 3400 W 131ST ST WESTFIELD, IN 460748267 r Z-"��-7 (317)733 -2001 `I 1 VENDOR PO# 8972556 VENDOR 513151 BWI COMPANIES INC CREATE DATE 10/09/09 STATUS Pending STATUS DATE 10/09/09 OPERATOR 624000104 Chanda Poland EXTENDED SKU DESCRIPTION PART QTY PRICE DISC AMOUNT 0222220. WET 998K 998i�, 1 94.87 0.00 94.87 8601004 SCO FREIGHT 1 12.50 0.00 12.50 SUBTOTAL 107.37 TAX 0.00 TOTAL 107.37 PAID AMOUNT 0.00 BALANCE DUE 107.37 PAYMENT HISTORY DATE PAYMENT TYPE AMOUNT e U�j 1� J REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TO: TRACTOR SUPPLY COMPANY 7 S U Pnyco P.O. Box 689020 Tractor 5upr�ly Cu irlpanY Des Moines, IA 50368 181 U.S. 31 Nopth TSC TEAM MEMBER TO COMPLETE Westf field, tN `6074 Please include 16 Digit Account Number (317) 80 3505 6035 301# NAME CARMEL STREET DEPT 3400 Q 131;51 8T WESTFIELD IN 460748267 ADDRESS (117) 733 2001 CITY STATE ZIP PHONE 431 431000182 2 9670148 07/29/2009 03 CUSTOMER TO COMPLETE 1890995 S &R 121N RECEIVER TU 1,00 0 24,99 24.99 NT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT. Government' A5encie The undersigned certifies The undersigned party certifies their exemption from D© compliance with the agricultural Subtotal 7.4,,, sales tax exam tion law of the state payment of sales and use tax on tangible personal 7.00: Tax 0,00 p property as indicated below and /or purchaser is' indicated below and understands engaged in the business of agricultural production of Total 24,,r, and agrees with the General g p TSC Card 24,9,' Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for Accttr *4803 the applicable statement of the resale and /or uses the farm machinery, equipment or fluth$•:029204 Ref 4:29141 1 6 respective state printed on the other agricultural production items purchased free of PO 1; Shop reverse side of this form. tax, as defined by state law, and as indicated below. Chasse 0100 The u ndersigned art further certifies the Cash Back PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty y STATE: understand they may be liable for payment of all taxes Buyer acknowledges the receie° t ot a• n0le (REQUIRED) due on the purchase price for the goods as allowed b1X. d (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. copy of thif, sales 5liF and the r urcha5e D f PURCHASER IS ENGAGED IN: (REQUIRED) F1 Resale Under penalty of perjury, signee swears the the described merchandise shall 6e in Government information on this statement is true and correct in accwrdanci with the Cardhol&f r Asrs en.ent. Exempt organization every material manner. A willfully false representation Agricultural Production of exemption will cause the purchaser to be subject to 7t Dairy Production penalty and /or other provisions as allowed under state Si sna 4141 e" LlvestoakProduction _W_________ Floriculture /Aquaculture Production law. ITEMS PURCHASED WILL BE USED FOR: (REQUIRED),. Farm Machinery /Repatr.:Parts Government Agency (Entity j 3 Llvestockln )estiblesDrin(ectibles ExemptOrganiiaiion' Entity I f', I,' Cal) 900 within t''&YS tcl IVC: only US Government are exempt t �jiit'ri1 Cm�lett a ,5urvtay and be entered r in 0 Fertrhzer /Agnchemrcalsr r,;..: DOT and itg j monthly dr;iwi.13 ftlr a tharce to win a Resale (Sales Tax Permd 1) I I 1 2900 shop i rl3 se reI.;' Consum m Production (KS) u r t Y E I r, Pi +1t ❑I fl rl c hl tiorComponentParis (KS1s. (Awarded a5 Gif.t Card) NO t'Util;tif� C Ingredlen OR SURVEY NECESSARY Emis 9/30/0 Other �,t -s 11�� t r i r,eJl "r�tY,tl ES #SEESa; E8 ##9tE#YE8EE #Sk #rX ##Sdk; Y1 t �4 r yi y, t CV ST®ME ?NATURE: (REQUIRE j MGR.APPROVAL �2 c) x USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. CASH CHECK- VISA M /C• `DISQOVER TSOCHARGEACCOUNT CHG.EXCH `.D`ATE f ITEM DESCRIPTIO NUMBER UNIT PRICE Form No. 9e -00401 (12/08) CUSTOMER ORIGINAL REMIT TSC BUSINESS ACCOUNT PAYMENTS ONLY TA TRACTOR SUPPLY SUPnY P.O. Box 689020 fractur :;uprl- Cw;w -iny Des Moines, IA 50368 l 31 8c'vOi TSC TEAM MEMBER TO COMPLETE 41.:ss.f i� w, "r;1 4G:7t 1 Please include 16 Digit Account Number 6035 301# NAME Cgfi' 11L 5 f 1 =:L 1= I UPI 3400 W 131ST ST ADDRESS WESIF tE1-C IN 46C (317) 733-'2301 CITY STATE ZIP PHONE 431 431000147 2 5 eO371 10/13/2009 11 05api CUSTOMER TO COMPLETE 11500"et1 PULLER UM IN 60 1 0`.I. 1.00 1, 31 31 rr'i NIT CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: GDverowet)t Asenc "i"es The undersigned certifies The undersigned art certifies their exemption from 11`'1074 LINK Ctltdi'i 60 comp liance with the agricultural g party p 1.00 e 3,99 ?.U9 NT p g payment of sales and use tax on tangible personal sales tax exemption law of the state property as indicated below and /or purchaser• is tiovert7,nent t= 1tieacie, indicated below and understands engaged in the business of agricultural production of and agrees with the General Subtotal 35.98 Exemption Statement at right and food or fiber, horticulture, aquaculture of floriculture for 7 Tay 4 U;1 the applicable statement of the resale and/or uses the farm machinery, equipment or Total 3. n8 respective state printed on the other agricultural production items purchased free of IBC Card �5 9C. reverse side of this form. tax, as defined by state law, and as indicated below. Pw th4i:013132 R._1t:13100 PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they P0 4: shot STATE: understand they may be liable for payment of all taxes Chanse 0 UQ (REQUIRED) due on the purchase price for the goods as allowed by Cash (tack (Exceptions: Georgia, New York s Kentucky state law should such goods be used or consumed in COMPLETE REVERSE SIDE) a taxable manner as defined b state laws. Y Buyer ackncauledies the rec6�i.ax of a c.or.INI PURCHASER IS'ENGAGED IN: (REQUIRED) t f d Resale Under penalty of perjury, sig nee ,swears the ca,'v of this sales slit and thr I =tlrcft,;-,e 0 Government information on this statement is true and correct in Ekempt, organization every material manner. Awillfully false representation,; the descri,t,ijd nittrcttaoi�i.�e yttall be in F1 Agricultural Production of exemption will cause the purchaser to be subject to acr.nrdt;,ce wt, E1, tine Cal' a euirSr flsr eemetr t auy Production penalty and/or other provisions as allowed understate 11 t? �J Livestock'Prcduction in FlonculturelAquaculture Production" J]iOther r.' Gignature: Farm R /R aIr Parts UIRED) ITEMS PURCHASED WILL BE USED FOR REQ I ry p Governmert Agency (Entity lr t s i r� '1 r Livestock 1n)estlbies or ln)ectibles 1 �I Exempt Organization (Entltyr# tr1, id'a k m r 1 ti #t #1f #3#£tt f�'En$ #u$AcwfYd1�1'sj, ;NC only DOT and US Government are exempts j Fertlliier/Agnchemicals 5 t tt, j+ tl 111l L x'$& i 3I s;t q" 3is i r pr Consumediln Production (KS} Di ,Resa {Safes Tax Permit 1 tit k i t 800 i6° Ct, K.'1 �€i 41i1r1, t i ars i0 pli Y Ingredle ;tor, ti re I+ .ItnF �7 -�T( F';�. R1�1:1it.IZ�,Y.Ut'43t9:�Tla l'lYT..e- Oihe� i i F j rw Isltl t� s Yl jtl �Lf•)(1.0 �tloeI (is '13 t t r f' Eh, i t 1 'r .t t7 f U�f'C11 tVJ t�uhCltf +GC I •.T 4'a, n..�F c .J. 1 e'.Ir: I.s .z T f f� Y..•i. t h ;UO R I GN TURE(REQUIREDI MGR. APPROVAL IN USE SHADED AREA ONLY WHEN REGISTER IS ITEM NUMBER �ASd' CHECtE" .VISA M!C 'DISCOVER`• TSOCMARGEACCOUNTNO ';',GHG, EXCH. "DATE DESCRIPTI Form No. 99- 00401.(12108) CUSTOMER ORIGINAL Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/01/09 $537.31 11/01/09 $66.26 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 VOUCH NO. WARRANT NO. ALLOWED 20 Tractor Supply IN SUM OF P. O. Box 9020 Des Moines, IA 50368 -9020 $603.57 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 43- 560.01 $537.31 1 hereby certify that the attached invoice(s), or 2201 42- 370.00 $66.26 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 'Thur sday, November „05, 2009 !i :7 Street Commissioner Street Title Cost distribution ledger classification if claim paid motor vehicle highway fund