HomeMy WebLinkAbout196637 04/14/2011 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
0 r ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
INDIANA 46032 PO BOX 7226 CHECK AMOUNT: $12.91
CARMEL
INDIANAPOLIS IN 46207 -7229
CHECK NUMBER: 196637
CHECK DATE: 411 412 01 1
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 12.91F B -MARCH 2011 GOL
IV
Aathorved FAB —10 3 0 810
I decta a der naIties of perjury that this is a true. correct and c nip a return. Gl n
Total Sales of Food &Beverages (Do Not Include Tax)... A.
Date Phone r V G
Total Exempt Food Beverage Sales B. n V U
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C. I Z
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (1% ofLine Q........._
0003120155 009 0 MAR 2011
Collection Allowance (.73 %of Line D)
Do Not Use this Line ifthe Payment is Late E.
County /Town Due on or Before Net Tax Due (Subtract Line a from Line D) F.
Penalty is Greater cf 55 or 10% of Line F (Plus Interest)
Hamilton MAY 02 2011 Use this line only ifretum is filed late G.
'The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached)....._ H.
l ttltltltittnlln ltlttliltnlltttlll Total Amount Due (Total Lines F and G plus or minus H) L I
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
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whari -d FAB —10 3 0 810
X Signerure &�4 A
I deeia re under penal i s of Phone 1 I parjury that this is a true, correct and com re
Date
lyi< Total Sales of Food Beverages Do Not Include Tax)......... A. f L'
Total Exempt Food Beverage Sales B. C G 0 0
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C. Z
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I% of Line Q... D. C' C
Collection Allowance (.73 %of Line D)
0003120155 009 0 MAR 2011 Do Not Use this Line ifthe Payment is Late E.
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of S5 or 10% of Line F (Plus Interest)*
Carmel MAY 02 2011 Use this line only ifretum is filed late G.
'The2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached) H.
Inlrlt ltl ►ntllnitlnitiutlltt,lll Total Amount Due (Total Lines F and G plus or minus H) I. Z I
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Ll�tltlit�ttl, Illtrtl t��Ilttrlttl�IttlJltltttt ltllllr�lltttl 080000113554951010252929115970331201100
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Aft
t I
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
6� o-
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
A AA
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund