238742 11/04/14 9`y "p"° CITY OF CARMEL, INDIANA VENDOR: 00350929
® ; ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $*******110.21
;, =a CARMEL, INDIANA 46032 PO BOX 7229 CHECK NUMBER: 238742
''��'rox��, INDIANAPOLIS IN 46207 CHECK DATE: 11/04/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 10/14 1 110.21 F & B—GOLF 10/14
Xs��e, A , ry FAB-103 0812
I declar
e
?nper penalties of perjury that this is
a true,correct and complete re
Date 1 v Phone 2� 571 21�� Total Sales of Food&Beverages(Do Not Include Tax)
Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A) C I I` .( Q)( S
Taxpayer ID Number For Tax Period Tax Due(1%ofLine C)
I'
OCT 2014 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late
0003120155 004 0 Due on or Before
DEC 01 2014 Net Tax Due(Subtract Line E from Line D) F I I
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only ifrettun is filed late (,
❑Check if Amended Hamilton-29000 *The 2014 Annual Interest Rate is3%
III I I I I I I I III I I Adjustments(An explanation must be attached) g
r r r t t t Total Amount Due(Total Lines F and G plus or minus H)_ I
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
LI��L11��1�LIII���L�111���1��1�11�LILI����LIL1�111��t1 08000011355495007,02529000159710311201405
e� eY,F
Authorized r ,,. � ,,�..; .� FAB—10 3 0 812
Xsigaature
I declaze un er7p tie of perjury thatthisis a true),correct and co et eturn. T
Date Wle, I Phone l (I n Total Sales of Food&Beverages(Do Not Include Tax)
F
Total Exempt Food&Beverage Sales B. .
CITY OF CARMEL BROOKSHIRE GOLF COUR
Net Taxable Sales(Subtract Line B from Line A)
CARMEL UTILITIES 11
Taxpayer ID Number For Tax Period Tax Due(1%of Line C)
OCT 2014 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late
0003120155 004 0 Due on or Before
DEC01 2014 Net Tax Due(Subtract Line E from Line D) F. I I •Z J
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only ifrettun is filed late G,
❑Check if Amended Carmel-29291 *The 2014 Annual Interest Rate is3%
Adjustments(An explanation must be attached) g
InI�I�I�In�11u�11nl�Itu�11�In11 Total Amount Due(Total Lines Fand Gplus orminus I)_ L I Q%2
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
080000113554951010252929115971031201405
Prescribed by State Board of Accounts City Forth 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
U 02AA04W Purchase Order No.
d IC4
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
a-
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 $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
IDI 1 l0 or bill(s) is (are) true and correct and that
the materials or services itemized thereon
i
for which charge is made were ordered and
received except
i
'i
' 20
m
Sign re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund