HomeMy WebLinkAbout196636 04/14/2011 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
0 CHECK AMOUNT: $12.91
CARMEL, INDIANA 46032 Po eox 7229
INDIANAPOLIS, IN 46207 -7229 CHECK NUMBER: 196636
CHECK DATE: 4/14/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 12.91F B -GOLF MARCH 201
X sis-r u, FAB —10 3 0 810
5,gnamre
I dada a der nalties ol'perjury that this is a true, correct and c nip a return.
Total Sales of Food &Beverages (Do Not Include Tax)......... A. U G
Date F'hone I r
Total Exempt Food Beverage Sales B. U
BROOKSHI RE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A).. C. Z
CARMEL UTILITIES /7
Taxpayer ID Number For Tax Period Tax Due (I %of Line C) D.
0003120155 004 0 MAR 201.1
Do Not Use this a
Collection Allowance (.73 %of Line D)
a tce 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 $5 or 10% of Line F (plus Interest)*
Hami ltcn 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) y,
In itlllIIIIIaIIItIIIIaIlltttllt tlll Total Amount Due (Total Lines F and G plus orminusH)
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
ItIttLllttttLllltttltttlltt tl�tltlttLlltlttttltlltLtlLttl 0800 00113554950010252900015970331201100
X Sign,t red s�
FAB -103 0810
Signature m
declare under penal o('perjury that this is a true. correct and re
Date phone —li F Total Sales of Food Beverages (Do Not Include Tax)......... A. r V'
Total Exempt Food Beverage Sales B. C V" C
BROOKSHIRE GOLF CLUB 7� Z
Net Taxable Sales (Subtract Line 8 from Line A)............. C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. l�
Collection Allowance (.73% of Line D)
0003120155 009 0 MAR 2011 Do Not Use this Line i£the Payment is Lace 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 I......... G.
"The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached)._ }I,
Initltillrtuilnitlttlwintiitttlll Total Amount Due (Total Lines F and G plus orminusH) I. Z f� f
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
LiItillLtttltllllttltttlitttlttltJttltiitlttttltlltlttllttti 080000113554951010252929115970331201100
Prescribed by Slate 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
t �nc l Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
i fr �_r
V I
Total
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
76
F
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Poo 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund