177873 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 306840 Page 1 of 1
ONE CIVIC SQUARE TRACTOR SUPPLY CO CHECK AMOUNT: $131.39
CARMEL, INDIANA 46032 PO BOX 689020
DES MOINES IA 50368 -9020 CHECK NUMBER: 177873
CHECK DATE: 9/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D
2201 4237000 STREET 131.39 6035301200050860
page 1 of 3 Tx 7 D 130000000 1Q
10FTRA Yi Vi
BUSINESS ACCOUNT
AGG�JUNT SUMMARY w....... w. 1..�
X6035 30 00050860 r
Previous Balance 306.98 Closing Date 09/18/09
Payments 374.58 Next Closing Date 10/20/09 CARMEL STREET DEPT
Credits 0.00 Payment Due Date 10/13/09 CINDY
Purchases 131.39 3400 W 131 ST ST
Debits 0.00 Current Due 63.79 WESTFIELD, IN 46074 -8267
FINANCE CHARGES 0.00 Past Due Amount 0.00 Credit Line 5,250
Late Fees 0.00 Minimum Payment Due 63.79 Credit Available 5,186
New Balance 63.79
CURRENT ACTIVITY
ransacti y
on L ocatio nt
Date pescnptian _e�� f
SEP 2 GOODS AND SERVICES WESTFIELD IN 48.09
TOTAL 6035301200074803 $48.09
AUG 19 GOODS AND SERVICES WESTFIELD IN 14.58
TOTAL 6035301200074837 $14.58
AUG 28 GOODS AND SERVICES NOBLESVILLE IN 13.74
AUG 28 GOODS AND SERVICES NOBLESVILLE IN 54.98
TOTAL 6035301202895866 $68.72
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Daily Days in ANNUAL Balance Daily Days in ANNUAL
Subject to Periodic Billing PERCENTAGE Subject to Periodic 9,11, g PERCENTAGE
Finance Charge Rate Period RATE Finance Charge Rate Period RATE
REGULAR REVOLVE CREDIT PLAN 0.00 .00000 so 0.00 0.00 .00000 29 0.00
-This-Account ttssued by Citibank Dakota -N.A:
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 Reqular Mail:
sent you the first statement on which the error or problem appeared. In your
letter, give us the following information: a 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. o Send payment by courier or express mall 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.
o. Full Balance S902TV 10/06
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III
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page 2 of 3 TX 7 D 1
BUSINESS ACCOUNT
CURRENT ACTIVITY
Transaction' Location/ y
w
k Descn tfons Amaunt
:r _.0�33�',,., �s
PAYMENTS, CREDITS, FEES, and ADJUSTMENTS
AUG 20 PAYMENT REF P9194007809NEDALX 89.61
SEP 11 PAYMENT REF P9194007Y09PLK7HN 284.97
This account is subject to the Alternate Balance Subject to Finance
Charge Calculation Method. See back for details.
Remit To: Bill To: page 3 of 3 1038
TRACTOR SUPPLY CREDIT PLAN ACCOUNT: 6035301200050860
DEPT.30 1200050860 JEFF STEWART ®SUMYC�
PO BOX 689020 211 2ND ST SW BUSINESS ACCOUNT
DES MOINES IA 50368 -9020
Payment Due Date: 10/13/09 Please make checks payable to TRACTOR SUPPLY CREDIT PLAN
SHIP TO: INVOICE: SHIP TO: INVOICE:
431000960671010 431000957371010
Purchase Order: Purchase Order:
SHOP PRESSURWASHER
AMOUNT DUE: 48.09 AMOUNT DUE: 14.58
Store: 574000431 INVOICE DATE: 09/02 /09 Store: 574000431 INVOICE DATE: 08/19 /09
CHAIN 5/16 GR70 TRANSPO 3586411 8.00 3.79 30.32 SPRAY TIP 25DEG GN QD 3 3823790 1.00 7.29 7.29
21/2 COARSE DRYWALL SCR 4050382 1.00 4.79 4.79 SPRAY TIP 2SDEG GN QD 3 3823790 1.00 7.29 7.29
NAIL 160 COMMON SLB BOX 4049569 1.00 6.99 6.99
PUNCH 3/16 ALIGNMENT 4002397 1.00 5.99 5.99 SUBTOTAL 14.58
TAX 0.00
SUBTOTAL 48.09 SHIPPING 0.00
TAX 0.00
SHIPPING 0.00 TOTAL 14.58
TOTAL 48.09
SHIP TO: INVOICE: SHIP TO: INVOICE:
624001183791010 624001183610010
Purchase Order: Purchase Order:
SHOP SHOP
AMOUNT DUE: 54.98 AMOUNT DUE: 13.74
Store: 574000624 INVOICE DATE: 08/28 /09 Store: 574000624 INVOICE DATE: 08/28 /09
F8R TRIBALL BALL MNT 21 1890686 1.00 49.99 49.99 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29
F8R PIN8CLIP 5 /8IN BKPV 1891137 1.00 4.99 4.99 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29
LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29
SUBTOTAL 54.98 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29
_TAX_. 0. 00 LOCKPIN SW 1/4 X 2 1/2 1853SS3_ 1.00 2. 29 _2
SHIPPING 0.00 LOCKPIN SW 1/4 X 2 1/2 1833553 1.00 2.29 2.29
TOTAL 54.98 SUBTOTAL 13.74
TAX 0.00
SHIPPING 0.00
TOTAL 13.74
Please Direct Inquiries to: Phone: 800 559 -8232 Fax: 801 779 -7425
REMIT TSC BUSINESS ACCOUNT
NO TBACTOR® PAYMENTS ONLY TO:
TRACTOR SUPPLY COMPANY
CWT 0gJ FnyC® P.O. Box 689020 Tractor Supply Company
Des Moines, IA 50368 18160 U.S, 31 North
Westfield.IN 46074
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number (317) 867 3505
6035 301
NAME CARMEL STREET DEF
3400 W 131ST ST
WESTFIELD IN 460748267
ADDRESS (317) 733 -2001
CITY STATE ZIP PHONE 431 786000104 2 957371
08/19/2009 02:28Pm
CUSTOMER TO COMPLETE 3823790 SPRAY TIP 25DEG GN 0
1,00 7.29 7.29 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
3823790 SPRAY TIP 25DEG GN 0
The undersigned certifies The undersigned party certifies their exemption from 1.00 7.29 7.29 NT
compliance with the agricultural payment of sales and use tax on tangible personal Government Asencies
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 14.58
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for 7,00% Tax 0.00
Exemption Statement at right and resale and /or uses the farm machinery, equipment or Total 14.58
the applicable statement of the other agricultural production items purchased free of TSC Card 14,58
respective state printed on the tax, as defined by state law, and as indicated below. Acct 2!333; ;4837
reverse side of this form. Autht:019347 Refs:1913281699
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they PO :Pressor washer
STATE: understand they may be liable for payment of all taxes Chanse 0,00
(REQUIRED) due on the purchase price for the goods as allowed by Cass1 Back
(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. Buyer acknowledses the receipt of a cor„Ple
PURCHASER IS ENGAGED IN: (REQUIRED) twd
Resale Under penalty of perjury, signee swears the copy of this sales slip and the Purchase a
Government information on this statement is true and correct iri
Exempt organization every material manner. A willfully false representation the described merchandise shalt be in
Agricultural Production of exemption will cause the purchaser to be subject to accordance with the Cardholder Asreeetent.
Dairy Production penalty and /or other provisions as allowed under state
Livestock Production
Floriculture /Aquaculture Production law.
5isnature:
Fl Other:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Injestibles or Injectibles I] Exempt Organization (Entity
Fertilizer /Agrichemicals NC: only DOT and US Government are exempt
Consumed in Production (KS) Resale (Sales Tax Permit Call 800- 968 -0734 within 7 days to
complete a survey and be entered in a
Ingredient or Component Parts (KS) monthly drawins for a chance to win a
Other: $2500 shuppins spree.
(Awarded as Gift Card) NO PURCHASE
CUSTOMER SIGNATURE: (REQUIRED) MGR. APPROVAL
2 �l X
SHA USE AREA ONLY WI-ItN IS INOPERATIVE.
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO. CHG. EXCH. DATE
ITEM NUMBER DESCRIPTIO
Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL
REKNIT TSC BUSINESS ACCOUNT
PAYMENTS ONLY iliilV j 11 TRACTOR SUPP Y O COMPANY
7SUPPLYCOM P.O. Box 689020
Tractor 3uI=rir Company
Des Moines, IA 50368 2375 East Pleasant St.
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Noblesvi i le IN 46060
6035 301 317) 776 -1 btt3
NAME CARMEL STREET DENT
3400 W 131ST ST
ADDRESS WESTFIELD IN 460748267
(317) 733 -2001
CITY STATE ZIP PHONE 624 624000104 Z 1183610
08/28/2009 10:09am
CUSTOMER TO COMPLETE 1833553 LOCKPIN SW 1/4 x 2 1
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: 1100 Government A Agensen z•7.9 NT
cies
The undersigned certifies The undersigned party certifies their exemption from 1833553 LOCKPIN SW 1/4 X 2 1
compliance with the agricultural payment of sales and use tax on tangible personal 1.00 2.29 2.29 NT
sales tax exemption law of the state Property as indicated below and/or purchaser is Government Agencies
indicated below and understands engaged in the business of agricultural production of 1833553 LOCKPIN SW 114 k 2 T
and agrees with the Genera! food or fiber, horticulture, aquaculture of floriculture for 1 •00 Z. 29 2.29 NT
Exemption Statement at right and resale and /or uses the farm machinery, equipment or Government Agencies
the applicable statement of the other agricultural production items purchased free of- 4 933553 LOCKPI14 SW 1/4 X 2 1
respective state printed on the tax, as defined by state law, and as indicated below. 1.00 2.29 2.29 NT
reverse side of this form. Government ASencie5
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they 1833553 LOCKPIN SW 114 X Z 1
STATE: understand they may be liable for payment of all taxes 1.00 2,29 2.29 N
due on the purchase price for the goods as allowed by GQvernmen t 145ellc ies
(Exceptions: Georgia, New York 8 Kentucky state law should such goods be Used or consumed In 1833553 LOCKPIN 5W 1/4 X 2 1
COMPLETE REVERSE SIDE) r
a taxable manner as defined by state laws. 1100 2.2) 2.79 N'l'
PURCHASER IS ENGAGED IN: (REQUIRED) Government A5encie5
Resale Under penalty of perjury, signee swears the
Government information on this statement is true and correct in Subtotal 13.74
Exempt organization every material manner. A willfully false representation 7.00% 'fax 0.00
Agricultural Production of exemption will cause the purchaser to be subject Total 13.74
Dairy Production penalty and /or other provisions.as allowed under state TSC Card 13.74
Livestock Production law. Acct t t 4 s t J s t t t t: s 5r; 6
Floriculture /AquacultureProduction Auth* :028301 he ot:2809093703
Other: PO shup
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) Chanse 0100
Farm Machinery /Repair Parts Government Agency (Entity 1 Cash Back
Livestock Injesfibles or Injectibles Exempt Organization (Entity Buyer acknowled5es the receipt of a camp le
Fertilizer /Agrichemicals INC: only DOT and US Government are exempt t,.0
Consumed in Production (KS)
Resale (Sales Tax Permit copy or this sale/ sltr and the Purchase o
1
Ingredient or Component Parts (KS) rye diescr.ibed In r`iTd?di_e shall bP in
Other: accardance with the C rdh )lder Agreement.
U TOMER I NATURE: QUIRED) MGR. APPROVAL ttsp a t i o
USE SHADED. AREA ONLY
ASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT NO: CHU, EXCH. DATE
QUANTITY ITEM NUMBER NON DESCRIPTION
TAX
Form No. 99 -00401 (12/08) CUSTOMER ORIGINAL
REMITTS BUSINESS ACCOUNT
PAYMENTS ONLY TO:
TRACTOR SUPPLY COMPANY
Su"LYCOM P.O. Box 689020 Tractor SUPp1Y COMPaDY
Des Moines, IA 50368 2375 East Plewiant S t,
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number Ncoble5vil le. IN 46060
6035 301 .317) 776 1683
NAME CARMEL STREET DEFT
3400 W 131ST Sl'
ADDRESS WlSTFIELD IN 460748267
13171 733 -2001
CITY STATE ZIP PHONE 624 624000103 1 11 63791
08/26/2009 02:57prn
CUSTOMER TO COMPLETE 1690666 F&R IRIBALL BALL iFNT
1,00 8 49,99 49.:9 N'r
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: GDvernolent Asencies
The undersigned certifies The undersigned party certifies their exemption from 1831137 F&R PIN&CLIP 5 8IN i:1
compliance with the agricultural 1 .00 R 4.99 4.99 NT
sales tax exemption law of the state payment of sales and use tax on tangible personal Government Asencie:;
indicated below and understands property as indicated below and/or purchaser is
General engaged in the business of agricultural production of
and agrees with the Subtotal S4,I8
Suhta
Exemption Statement a right and food or fiber, horticulture, aquaculture of floriculture for 00*' bto Tax 0.00
resale and /or uses the farm machinery, equipment or
the applicable statement of the Total 54.98
respective state printed on the other agricultural production items purchased free of TSC Card 54.98
reverse side of this form. tax, as defined by state law, and as indicated below. Ac-ctt.:Att#YtttYYt #5666
The undersigned art further certifies the Auth *:028982 Ref #:2813570636
PRODUCT IS TO BE USED IN THE FOLLOWING 9 p arty y PO a sh op
STATE: understand they may be liable for payment of all taxes Chance 0.00
(REQUIRED) due on the purchase price for the goods as allowed by Cash Bac
(Exceptions: Georgia, New York 8 Kentucky- state law should such goods be used or consumed In
COMPLETE REVERSE SIDE)
a taxable manner as defined by state laws. Buyer acknawled5e5 the receipt of a coriwle
PURCHASER IS ENGAGED IN: (REQUIRED)
Resale Under penalty of perjury, signee swears the copy of this sale;, slip and the purcyase r;
F Government information on this statement is true and correct i
Exempt organization,. every material manner. A willfully false representation
E] Agricultural described merchandise sha ll Agricultural Production of exemption will cause the purchaser to be subject to in
Dairy Production penalty and /or other provisions as allowed under state accordance with the ndise s steal l Ft in nt.
Livestock Production law.
Floriculture /Aquaculture Production
Other: Signature:
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED)
Farm Machinery/Repair Parts Government Agency (Entity
Livestock Iniestibles or Injectibles Exempt Organization (Entity 1
Fertlizer /Agrichemicals
NC: only DOT and US Government are exempt tt3t333tt #tEtt #Lt##,tYtittt.tt
Consumed in Production (KS) Resale (Sales Tax Permit 1 Call 800 968 0734 within 7 days to
Complete a survey and be entered in a
F] Ingredient or Component Parts (KS) monthly drawing for a chance to wi.n a
Other: $7500 5huprio!3 spree.
(Awarded as Gift Card) NO PURCHASE
CUST9MEf1 SIGNATURE: EQUIRED) MGR. APPROVAL
n
�I X
USE SHADED AREA ONLY
CASH CHECK VISA M/C DISCOVER TSC CHARGE ACCOUNT N0. CHG. EXCH. DATE U. hE
UUANIIIY ITEM NUMBER DESCRIPTIO
Form No. 99 -00401 (12108) CUSTOMER ORIGINAL
REMIT TSC BUSINESS ACCOUNT
PAYMENTS ONLY TO:
TRACTOR SUPPLY COMPANY
low1 yco P.O.. Box 689020 Trac'ri3r allpf l.r Gantpany
Des Moines, IA 50368 1 8160 U.S. 31 Nor
Wesfffeldl IN 46074
TSC TEAM MEMBER TO COMPLETE Please include 16 Digit Account Number 1317) 867 3Si1S
6035 301
CARMEL STREET DEPT
NAME 3400 W 1315T S'l
_iL WESTF'IELD IN 460740167
ADDRESS (31 7) 7 33-•2001
CITY STATE ZIP PHONE 431000172 2 960671
09/OZ/2009 10 25a4it
CUSTOMER TO COMPLETE 3566411 CHAIN 5/16 GR70 TRAM
8100 C 3.79 30,32 NT
CERTIFICATE OF EXEMPTION: GENERAL EXEMPTION STATEMENT: Government Asencies
ned certifies 4050382 21 /2 COARSE DRYWALL
The undersigned The undersigned party certifies their exemption from 1 00 4.79 4 79 NT
compliance with the agricultural payment of sales and use tax on tangible personal Government Aoencies
sales tax exemption law of the state property as indicated below and /or purchaser is 4049569 NAIL 16D COMMON 5LB
indicated below and understands engaged in the business of agricultural production of 1.00 Ca 6,99 6,99 NT
and agrees with the General food or fiber, horticulture, aquaculture of floriculture for Government Asencie s
Exemption Statement at right and resale and /or uses the farm machinery, equipment or 400235`7 PUNCH 3/16 ALIGNMENT
the applicable statement of the other agricultural production items purchased free of 1.00 P 5.99 5.99 NT
respective state printed on the tax, as defined by state law, and as indicated below. Governmell t Asencie5
reverse side of this form.
PRODUCT IS TO BE USED IN THE FOLLOWING The undersigned party further certifies they Subtotal. 48.09
STATE: understand they may be liable for payment of all taxes 7. 00% T ,x 0,00
(REQUIRED) due on the purchase price for the goods as allowed by Total 48.09
(Exceptions: Geor Newyork Kentucky state law should such goods be used or consumed in TSC Card 40,09
COMPLETE REVERSE SIDE) a taxable manner as defined by state laws. Acc t' #f a i t it t t4803
PURCHASER IS ENGAGED IN: (REQUIRED) Au tho 002413 Ref to 02092 ;250 t
Resale Under penalty of perjury, signee swears the ro t.: Shop
Government information .on this statement is true and correct in Chanse 0,001
Exempt organization every material manner. A willfully false representation CBtsh $ack
O Adricu)tural Production of exemption will cause the purchaser to be subject to
0 Dairy Production penalty and /or other provisions as allowed under state Buyer acknowledse,s the receipt of a comple
Livestock Production law. t e J
E]. Floriculture /Aquaculture Production copy of this sales ship and the Purchase o
.,Other: f
ITEMS PURCHASED WILL BE USED FOR: (REQUIRED) t17e described merchandise shall be ir1
Farm Machinery/Repair Parts E] Government Agency (Entity 1
accordance with the Cardholder Agreement,
Livestock Injestibles or Injectibles Exempt Organization (Entity 1
Fertiliser /Agrichemicals NC: only DOT and US Government are exempt Si.snottn e
Consumed in Production (KS} 0 Resale (Safes Tax Permit il
i
Q Ingredient or Component Parts (KS)
Other;
C uSTO S (REQUIRED) MGR. APPROVAL
X
USE SHADED AREA ONLY WHEN REGISTER IS INOPERATIVE. 7
A H CHECK VISA MX; DISCOVER TSC CHARGE ACCOUNT N0. CHG: EXCR. DATE
DESCRIPTIO
ITIEWINUMBEIR Form No. 99 -00401 (12/08) 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))
09/15/09 $131.39
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
VOUCHER NO.' W NO.
ALLOWED 20
Tractor Supply
IN SUM OF
P. O. Box 9020
Des Moines, IA 50368 -9020
$131.39
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 42- 370.00 $131.39 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursdely, Sep er 24, 2009
Street Commissro er
tpe"e• 4•'lJi�llf fi.'3J1 I
er
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund