234462 07/08/2014 CITY OF CARMEL, INDIANA VENDOR: 00350929
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ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $****"**232.73"
CARMEL, INDIANA 46032 PO BOX 7229 CHECK NUMBER: 234462
INDIANAPOLIS IN 46207 CHECK DATE: 07/08/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 6/30 2 232.73 OTHER EXPENSES
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Authorized FAB-103 0 812
X Signature
I declare nde r penalties of pedury that this is a true,correct and cora at return.T �7 z'l
Date Phone ti Total Sales of Food&Beverages(Do Not Include Tax) A.. -3 JV
11„ Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A) C. Z3.
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D.
JUN 2014 Collection Allowance(.73%of Line D) i
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E., / I
JUL 30 2014 Net Tax Due(Subtract Line E from Line D) F. J
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 2014Annual Interest Rate is3%
Adjustments(An explanation must be attached) H,:
Ittlil�l�li�tltltt�ll�t�llittlltlt�ll Total Amount Due(Total Lines F and G plus or minus M I. Z'3 Z'q
INDIANA DEPARTMENT OF REVENUE
P•0• BOX 7229
INDIANAPOLIS, IN 46207-7229
I�Ir�l�ll�rerl�lll��rlrr�ll�r�l��l�l�rl�ll�l�tr�lrll�lrrllrr�l 0800❑0113554950010252900015970630201409
Xss N d i �,� FAB-103 0812
I declare un�yr p nal['es ofperjury that this is a true,
'cortect and rn
c mpl r u . l
Date .7.1 �j Pho7
ne / I r F Total Sales of Food&Beverages(Do Not Include Tax) A. V
Z 7
B.
CITY OF CARMEL BROOKSHIRE GOLF COUR Total Exempt Food&Beverage Sales( )
CARMEL UTILITIES Net Taxable sales SubtractLineBfromLineA C. 1z-
JUN
7 `I
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D, z-
JUN 2014 Collection Allowance(.73%ofLine D) I
0003120155 009 0 Due on or Before Do Not Use this Line if the Payment is Late E.
JUL 30 2014 Net Tax Due(Subtract Line E from Line D) F. .z J Z-7
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 Carmel-29291 *The 2014 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
Iriltlrlil�trltlr�rll�rTll�i�lltl�rll Total Amount Due(Total Lines Fand Gplus orminus H)_ I. ZJ2.73
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
IrLrLIlt�rrlrlll�r�Ir�rllr�rl��I�L�I�ILL���l�ll�lr�ll��tl ❑800❑❑113554951010252929115970630201409
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth No.201(Rev.1995)
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))
-
Total
I 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
IN SUM OF $
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1 a0
$
ON ACCOUNT OF APPROPRIATION FOR
a
Board Members
f
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
o -73 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
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I
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I
20
Signature
f
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund