188684 08/17/2010 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $340.90
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 188684
CHECK DATE: 8/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOIC NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 7 340.90 F& B -GOLF 07/10
-103 0809
I declare u der nullt of perjury that this is a tra correct an f cwllplete n.
Date G Phone )I I 1 IfI Total Sales of Food Beverages (Do Not Include Tax) A. I I 6 D 0
Total Exempt Food &Beverage Sales B.
BROOKSHIRE GOLF CLUB C}
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due 0% of Line C).-- D.
p003120155 004 0 JJL 2010 Collection Allowance (.73 %ofLineD) I
Do Not Use this Line if the Pavment is Late E. r
County /Town Due on or Before Net Tax Due (Subiract Line Q from Line D F. L 1
Penalty is Greater of S5 or 10% of Line F (Plus Interest)
Carmel AUG 30 2010 Use this line only ifretumis filed late G.
'The 1 010 Annaal Interest Rate is 4,
Adjustments (An explanation must be attached)....._ y,
It�ltltltlti�lrltlrtlrtlrllrtlllllttl Total Amount Due (Total Lines F and G plus or minus 11)
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I., ItIlt�r�IJlltttl��tll���lt�ltl�tl�llrlt�t�ItlltLtll��tl 080000113554951010252929115970731201004
,.I b ;ter
103 0809
17� 51q�arurc
1 de I de penelnes o1'perjury that this is a trait, correct and c r unple ret u.
Date I Total Sales of Food Beverages (Do Not Include Tax) A. f
1 Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I %of Line D.
Collection Allowance (.73 %of Line D) I
0003120155 004 0 JUL 2010 Do Not Use this Line ifthe Payment is Late E.
County /Taws Due on or Before Net Tax Due (Subtract Line E from Line D F.
Penalty is Greater of $5 or 10% of Line F (Plus Interest)"
Hamilton AUG 30 2010 Use this line onlvifretumis riled late G.
'The 2410 Annual Interest Rate is4%
Adjustments (An explanation must be attached) H
I ttlilrlrl n tltlrltrlr�ltlttrlllltttl /�r I
j Total Amount Due (Total Lines F and G plus or minus H) 1.$ f G
/J
I INDIANA DEPARTMENT OF REVENUE
f P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
1 l �Itrl�ll�t��itlllt��l��tllt�tl�tl�l�tltlltlt��tltlltl�sllt��l 080000113554950010252900015970731201004
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
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 accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
f IN SUM OF
d1
�J q6a0
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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund