192471 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7218 CHECK AMOUNT: $903.13
INDIANAPOLIS IN 46207 -7218
CHECK NUMBER: 192471
CHECK DATE: 12/712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4359200 PARKS -11 /10 903.13 MONON —NOV 2010
X sig"k;,.ed
ST -103 01809
Sigimgve
I deelare under penalties of periu t this is a true, one t and complete return.
Date 1,2 ate/ Phone 4�
I
Total Sales 1 [G
CARMEL CLAY PARKS AND RECREATION Exemptions Deductions 2
Taxable Sales (Line 1 2) 3.
Taxpayer ID Number For Tax Period Total Tax Due (7% of Line 3) 4, U
Discount (Collection Allowance
0119683083 001 7 NOV 2010 .73% of Line 4) 5•
Use Tax Due (7% X Purchases) 6.
Filing status Due on or Before Interest Due (Line 4 Line 6) x Int Rate* 7.
*The 2910 Annual Interest Reteis4%
MONTHLY DEC 30 201
Penalty Due 8
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Payment Previously Made (EFT) 9
INDIANA DEPARTMENT OF REVENUE Amount Due
P.O. BOX 7218 (Add Lines 4 6 7 8 minus 5 9) 10.$ .3'
INDIANAPOLIS,IN 46207 -7218
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
00350929 Indiana Department of Revenue Terms
P.O. Box 7218 Date Due
Indianapolis, IN 46207 -7218
Invoice Invoice Description
Amount
Date Number (or note attached invoice(s) or bill(s))
1212110 0119683083001 7 Sales tax paid Nov'10 903.13
Total 903.13
1 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
00350929 Indiana Department of Revenue Allowed 20
P.O. Box 7218
Indianapolis, IN 46207 -7218
In Sum of$
903.13
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
1091 0119683083 001 7 4359200 903.13 1 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
2 -Dec 2010
l
Signature
903.13 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund