182165 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
`i' of ONE CIVIC SQUARE INDIANA DEPARTMENT OF REVENUE
si
ra CARMEL, INDIANA 46032 Po sox 1028 CHECK AMOUNT: $96.45
w p INDIANAPOLIS, IN 46206 -1028 CHECK NUMBER: 182165
CHECK DATE: 21312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1 01 5023990 96.45 TAXES
AR -80
PROPOSED ASSESSMENT 211
SF 43430 (Rev, 1/2001) INDIANA DEPARTMENT OF REVENUE
REFER TO THIS NUMBER ON ANY CONTACT WITH THE DEPARTMENT Liability Number: 2008 00260537
Notice Number: 09029008190
Date Issued: 12/23/2009
Taxpayer TID: 0003120155 001
FID: 35- 6000972
Form Number WH -3
0900067763560
11111 1111111111111111111111 11111111111111111111111111111111111111111I1111011111111 DLN: 09Z0001611965
CARMEL UTILITIES Account ID: 107719648
CITY OF CARMEL Liability Period: December 31, 2008
1 CARMEL CIVIC SQ Tax Type: Withholding
CARMEL, IN 46032
•'-i
A review of your Indiana Withholding tax return(s) for the period ending December 31, 2008 has determined you may
owe $96.45. This amount includes penalty and interest required by state law.
If you agree with the explanation given on the reverse side of this notice, the amount must be paid by February 8, 2010.
If you do not agree, you have 45 days to submit a written protest with supporting documentation. Your protest must
be received by the due date.
If this business is closed, you must file form BC -100 with the Department and attach supporting documents. You can
find the BC -100 at www.in.gov /dor, or visit any district office. You can also call us at (317) 233 -4015 and have one
mailed to you.
SUMMARY OF AMOUNT DUE
Original Tax (Withholding) 1,492,638.46
Credits 1,492,556.05
Penalty 8.24
Interest Daily Amount $0.02 5.80
Amount you owe Due Date: February 8, 2010 96,45
DETACH AND MAIL BOTTOM PORTION WITH YOUR PAYMENT (MADE PAYABLE TO THE INDIANA DEPARTMENT OF REVENUE).
CARMEL UTILITIES
Taxpayer TID: 0003120155 001
Liability Number: 2008- 00260537
Notice Number: 09029008190
AMOUNT Due Date: February 8, 2010
PAID
Indiana Dept. of Revenue
PO Box 1028
Indianapolis, IN 1028 11 111 AMOUNT YOU OWE: $96.45
I I 1 II I !II II IIII IIII IIII III
0100 31261550020 080026053764006DD00009645
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
T D eever)L4L_ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7e4A4/0 i4c "q
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO., WARRANT NO.
ALLOWED 20
(Vd DtPf Pithitrukt_
IN SUM OF$
(1 [s /I- h -06- jvaE
q
ON ACCOUNT OF APPROPRIATION FOR
a emog -1g/4/LW No Arp
Board Members
=15 r INVOICE NO. ACCT #/TITLE AMOUNT
I I hereby certify that the attached invoice(s), or
0 �jD 9G 4 g/ `t. 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
1/ e4 1
8
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund