190622 10/12/2010 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $273.36
INDIANAPOLIS IN 46207
CHECK NUMBER: 190622
CHECK DATE: 10/12/2010
DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 9 273.36 F& B -GOLF 09/10
XSe ati:e" l 0809
I de un er len Ities I hone yrat this is a true. correct and co plete re T 3 1 o
I� 5� I Z 1, H Total Sales oCFood Beverages (Do Not Include Tax) A.
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB i II 7
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES 3
Taxpayer ID Number For Tax Period Tax Due (I %of Line C) D.
0003120155 004 0 SEP 2010 Collection Allowance (.73% ofLine D) 1 I
Do Not Use this Line ifthe Payment is Late E. I
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of SS or 10% of Line F (Plus Interest)•
Hamilton NOV 01 2010 Use this line only ifretumisriiledlate G.
i
'The 2010 .Annual Interest Rate is 4%
Adjustments (An explanation must be attached) H.
C Inlrlrlrlrnllrllnrrlrlrntlllinrl Total Amount Due (Total Lines F and G plus or minus H) 1. i
INDIANA DEPARTMENT OF REVENUE
P -0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Pill 11111111111 080000113554950010252900015970930201006
c�✓ f�� B -103 0809
X Authori-d J
signeNI,
1 I declare under penal eoa{,�ett) 4 Hi r�u]. correct and complete rn.
I (l 11 Total Sales of Food &Beverages (Do Not Include Tax) A.
Date tZ I l I 10 Phone a
Total Exempt Food Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES l '�S�
Taxpayer ID Number For Tax Period Tax Due (I %of Line C) D.
Collection Allowance (.73% ofLine D)
0003120155 004 0 SEP 2010 I I
I Do Not Use this Line if the Payment is Late E.
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of SS or 10% of Line F (Plus Interest)'
Car me 1 NOV 01 2010 Use this line only ifretum is filed late G.
'The 2010 Annual Interest Rate is 4%
I
I I I I I I I I I I I I I I I I I Adjustments (An explanation must be attached) H.
r r r r r r r r r r r r r r r r r r r r Total Amount Due (Total Lines F and G plus or minus H) 1.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Irlr�lrllrrrrlrlllrrrlrrrllrrrlrrlrlrrlrllrlrrrrlrll�lrlll�r�l 080000113554951010252929115970930201006
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
U/\
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
IN SUM OF
C
ON ACCOUNT OF APPROPRIATION FOR
*WP 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
mater18ls 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