HomeMy WebLinkAbout197491 05/19/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7226 CHECK AMOUNT: $44.95
INDIANAPOLIS IN 46207 CHECK NUMBER: 197491
CHECK DATE: 5/1912011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 1 44.95 F& B -GOLF 4/11
Aut-i
FAB -103 0810
Signature nl
X
I declare under penalues of perjury that this is a true, correct and complet m. Q
'Total Sales of Food &Beverages (Do Not Include Tax)......... A. `f.S 1 U
Dote Phone y` O
Total Exempt Food Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C. U
CARMEL UTILITIES 5 a
Taxpayer ID Number For Tax Period Tax Due (I of tine C) D.
Collection Allowance (J3 %ofl_ine D)
0003/201 5 004 0 APR 2011 Do Not Use this Line ifthe Payment is Late E. 33
County /Town Due on or Before Net Tax Due (Subtract Line E- from Line D) F. 44
Penalty is Greater of S5 or 10% of Line F (Plus Interest)"
Carmel MAY 31 2011 Use this line only ifretum is filed late G.
'The Mi I Annual Interest Rate is 9%,
Adjustments (An explanation must be attached) H
I��I�Itl�l��r�lltlilitt�llit�lltt�lll 1' otalAmoumDue (TotalLinesFandGplusorminwhl) I.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
080000113554951010252929115970430201109
This area left blank intentionally.
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 i owt lu Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
-P6 IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
F
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
S�GC �S 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
