HomeMy WebLinkAbout197492 05/19/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
g� CHECK AMOUNT: $44.95
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 197492
CHECK DATE: 5/19/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 2 44.95 F& B -GOLF 4/11
Aa,hr,6,W 1 FAB --10 3 0 810
I declare under penahies of perjury that this is a true, correct and coy le return.
Total Sales of Food &Beverages (Do Not Include Tax)......... A.
Date Phone
Total Exempt Food Beverage Sales B. C? 0 C)
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES 01
Taxpayer ID Number For Tax Period Tax Due (1 %of Line C) D.
0003120155 004 0 MAY 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 E from Line D) F. 4 4 9
Penalty is Greater of $5 or 10% of Line F (Plus Interest)'
Carmel JUN 30 2011 Use this line only ifretum is filed late I G.
'The 201 E Annual Interest Rate is')%
a Adjustments (An explanation must be attached) H.
Itrltltltlttttl
Total Amount Due (Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE 1
P -0- BOX 7229
INDIANAPOLIS,IN 46207 -7229
1. 1IIIIIIII11111111 1111111111111111111111111 1I 1 0 8 0 0 0 0 1 1 3 5 5 4 9 5 1 0 1 0 2 5 2 9 2 9 1 1 5 9 7 0 5 3 1 2 0 1 1 0 8
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))
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
4 p� L� IN SUM OF
p eve A
I K
4
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
D r 7� 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