189637 09/13/2010 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
z ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
0 h CHECK AMOUNT: $289.44
CARMEL, INDIANA 46032 Po aox 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 189637
CHECK DATE: 9/1312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 08/10 289.44 GOLF -F B -08/10
B -1 03 0809
vtA�- .4uhori�ed k
declare and r Penn ties of perjury that tln.c i3 n true, correet and vntplet urn. 4
�^7 �J r
Dare �V Phone r {�J_I S J r Z �t-!' F Total Sales of Food Beserages (Do Not Include Tax) A. 1
fff Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB 5� 7
Net Taxable Sales (Subtract Line B from Line Al C.
CARMEL UTILITIES 1
Taxpayer ID Number For Tax Period Tax Due 0% ofLineC) D.
0003120155 0d4 0 AUG 2010 C: ollectionAllowance (.73 %ot'LineD)
Do Not Use this Line if;lte Payment is Late. E.
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D)---- F. f 1 I f r7�^
Penalty is Greater of SS or 10% of Line F (Plus Interest)`
Hamilton SEP 30 2010 Use this line only ifretumisfiledlate G.
•The 3010 Annual Interest Rate is 4%
I I I I I I I 11 I I I I I Adjustments (An explanation must be attached) H,
Total Amount Due (Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P -0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
11 11111, 11111 111111 1111 11 1111 ,L111111L1111111,11,111111 08000011355495001025290001597083 1201100
X Aulhon,rd F /l"` B —10 3 0809
AL n, 4 1 decline under penahie 1; c ect and complete rel
Dste Total Sale, of Food
Beverages (Do Not Include Tax)......... A. J
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
CARMEL UTILITIES Net Taxable Sales (Subtract Line B From Line A)_ C. f 46,
Taxpayer ID Number For Tax period Tax Due! 0% of Line C)....................................................... D.
0003120155 004 0 AUG 2010 Collection Allowance (.73% ofLine D)
Do Not Use this Line ifthe Payment is Late........ E. �7 (C
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D F. f 9
Penalty is Greater of SS or 10% of Line F (Plus Interest)"
Carmel SEP 30 2010 Use this line onlyifretumis filed late G.
'The 2010 Annual Interest Rate is 4N,
1 1 1 1 1 III I I I IIII I Adjustments (An explanation must be attached) H
11 1 1 11 11 1 1 Total Amount Due (Total Lines F and 0 plus or minus H) L (F 7
INDIANA DEPARTMENT OF REVENUE
P -O- BOX 7229
INDIANAPOLIS,IN 46207 -7229
1111, 111111111 111111 1111111 111 [sill 1111 /11111111111„111,11 0800001113554951010252929115970831201008
Prescribed by Slate 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))
U' t o
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
IN SUM o1*
�aoe-- JN)-
ON ACCOUNT OF APPROPRIATION FOR
bw thl a6d
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
RE 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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund