HomeMy WebLinkAbout195276 03/09/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
z CHECK AMOUNT: $36.88
CARMEL, INDIANA 46032 Po aox 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 195276
CHECK DATE: 3/9/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUN DESCRIPTI
101 5023990 F B -02/11 36.88 F B -GOLF 02/11
FAB -10 3 0 810
a Signu Nre
I deelare u der p tallies el' perjury that this is a true, wrrect and co tpl return. I C 12
f Total Sales of Food &Beverages (Do Not Include Tax) A. _J i, .J
Date I Phone 1 Z
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C. 3
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due I of Line C) D.
nce (.73% of Line D) I 4
Do Not 0003120155 009 0 FEB 2011 lt Use this Line ifth E.
e Payment is Late 1
County /Town 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)*
Carmel. MAR 30 2011 Use this line only if return is filed late G.
'The 2011 Arntnal Interest Rate is 9%
Ad justments (An explanation must be attached) y,
Ad p/
1, ,lll,l,l+llnllnl,l,lll+„Iltulll al Amount Due (Total Lines F and 6 plus or minus H) I. L
INDIANA DEPARTMENT OF REVENUE
P•0" BOX 7229
INDIANAPOLIS,IN 46207 -7229
I, +,I, II,,,, I 1111+„ I,+ +II,,,I„I,I„LII,L,,,LILI„II +1.1 O8000O113554951010252929115970228201100
FAB -103 0810
X Signature 1
I declare under na lti s o erjury at this �r t ru e... and complete n. �1
Ij Phone `l� l Z R}I Total Sales of Food Beverages (Do Not Include Tax)......... A.
Date 1
Total Exempt Food &Beverage Sales B.
BROOKSH IRE 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 C)... I D.
Collection Allowance (.73% of Line D)
0003120155 009 0 FEB 2011 Do Not Use this Line ifthe Payment is Late E. I
Count /Town Due on or Before Net Tax Due (Subtract Line E from Line D).........._......_........ F.
County/Town Penalty is Greater of$5 or 10% of Line F (Plus interest)'
Hamilton MAR 3D 2011 Use this line only ifretum is fled late G.
"The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached) H.
l„I, I I, I, I I u l l n l l 1, l„u, l 1,,, i l l Total Amount Due (Total Lines F and G plus or minus H) I. D
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I,I,II,II,, pill ll,,, I,,, II1 ,,I„I+IIJ,ILI +,,,l,ll,l,lll, 080000113554950010252900015970228201100
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
I Ad :k kf 0 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
ON ACCOUNT OF APPROPRIATION FOR
Board Members
D INVOICE NO. ACCT #!TITLE AMOUNT 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
14 44
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
