232671 05/14/14 (9,
CITY OF CARMEL, INDIANA VENDOR: 00350929
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: S"`"""`80.94`
CARMEL, INDIANA 46032 PO BOX 7229 CHECK NUMBER: 232671
INDIANAPOLIS IN 46207 CHECK DATE: 05/14/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B-4/14 1 80.94 F & B-GOLF 4/14 1
XAuthorized FAB-103 0 812
sige.wo
I declare d nalt,s ofluedury that this is a true,correct an c pl, a return
Date�' I-, I Phone ��" 1 Total Sales of Food&Beverages(Do Not Include Tax)_ A.
Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR
CARMEL UTILITIES Net Taxable Sales(Subtract Line Bfrom Line A) C. i
Taxpayer ID Number For Tax Period Tax Due(1%of Line C)
APR 2014 Collection Allowance(.73%of Line D) n
0003120155 009 0 Due on or Before Do Not Use this Lute if the Payment is Late
MAY 30 2014 Net Tax Due(Subtract Line E from tine D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only if return is filed late G,
❑ Check if Amended Hamilton-29000 *The 2014 Annual Interest Rate is 3%
11 1 1 11 I I I I I Adjustments(An explanation must be attached)
u I;
1 1 1 nn 1 1 1 lino 1 n
Total Amount Due(Total Lines F and G plus or minus IT)_ I. S o -
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
III 11I1IInu11IIIn1In111nIII I1IIII1IIII fill 11111111111111 08000011135549500102529000]15970430201401,
Xs gaat.ze — FAB-103 0 812
I declare u drer p al,s ofperjury that this is/a true,+co'rrJect lid complete
Date i Phove ey, �� 1// ( F Total Sales of Food&Beverages(Do Not Include Tax) A. I J lam'
Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR 9
Net Taxable Sales(Subtract Line B from Line A) C.
CARMEL UTILITIES I
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D.
APR 2014 Collection Allowance(.73%of Line D)
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late E;.
'
MAY 30 2014 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only ifretum is Sled late G.
❑Check if Amended Carmel-29291 *The 2014 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
111 1111 11111111 I 1 I 1 111 11111111 I 1 11111 Total Amount Due(Total Lines F and G plus or minus IT)_ I. qj
INDIANA DEPARTMENT OF REVENUE �'
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
I1I11I11I1111I11II1111111111�1I1111111LII I[111111111111111111 080000113554951010252929115970430201401
II
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.199
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
In
U dly 0- Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
� r
Total
hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
1
IN SUM OF $
Iltil 470
$ b
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I 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
20
/d,o A jl!�Aou AI
g ature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund