237711 10/02/14 ('����• CITY OF CARMEL, INDIANA VENDOR: 00350929
�;• ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $*******145.68*
f?q CARMEL, INDIANA 46032 PO BOX 7229 CHECK NUMBER: 237711
M,proN.�, INDIANAPOLIS IN 46207 CHECK DATE: 10/02/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2 145.68 F & B-GOLF 9/14
,r 5
XAuthorized '{ .� �},)J AB-103 0 812
Signature � �
I declaree un r p alties ofpedury that this is a true,come t and complete r6.r
'I �'] (�
Date 1 Phone �I /� „ Total Sales of Food&Beverages(Do Not Include Tax)_ A. `( / 5 l'
1 Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A) C.
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D.
SEP 2014 Collection Allowance(.73%of Line D) ( O
Do Not Use this Line if the Payment is Late E.0003120155 004 0 Due on or Before
OCT 30 2014 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)* + ' Q
County/Town Use this line only ifretum is filed late G.
❑Check if Amended Hamilton-29000 *The 2014 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
I o I I I I I I I I 1111 111111111 111111 Total Amount Due(Total Lines F and G plus or minus H)_ I. ! (� -mss. b g
INDIANA D DEEPARTMENN T OF REVENUE l
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
IIIIIIIIIIIIILIILIILt11.111111111II11�IIIIIIIIL111111111111 080000113554950❑1025290001597093❑201410
XAuthorized � d �, • FAB-103 0 812
Signature
I declar/e�u/n�de peva ties of pedury t2hat this is a true,correct aid compl tum. '
Date 1 V Phone/I J `'I ` Tota]Sales of Food&Beverages(Do Not Include Tax) A.
Total Exempt Food&Beverage Sales B.
CI"TY
OF CARMEL BROOKSHIRE GOLF COUR
Net Taxable Sales Subtract Line B from Line A 'C.
l
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D. I L iP
SEP 2014 Collection Allowance(.73%ofLine D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E. I 6`7
OCT 30 2014 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)* 10
Q.
County/Town Use this line only ifretum is filed late G. (�
❑Check if Amended Carmel-29291 *The 2014 Annual Interest Rate is 3%
I III I I Adjustments(An explanation must be attached) H.
n I I I nI I un1 nn I ni r� /_ ei
Tota]Amount Due(Total Lines F and G plus or minus M'
INDIANA DEPARTMENT OF REVENUE
P.0• BOX 7229
INDIANAPOLIS, IN 46207-7229
IIIIIIIIIIIIIIIII
111111111111111[Fill IIIIIII I III I III IIIII I 111 080000113554951010252929115970930201410
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
v✓ 1 �� � Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
F� 71l
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
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
660 I W
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
i
20
Signat
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund