HomeMy WebLinkAbout198331 06/15/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
O ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $109.68
CARMEL, INDIANA 46032 SYSTEM SERVICES
PO BOX 6197 CHECK NUMBER: 198331
INDIANAPOLIS IN 46206-6197
CHECK DATE: 6115/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2 109.68 F B TAX-5/11
wurbar;zM FAB -103 0810
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I declare under pen p at t oo ect and completer JU Total Sales of food Beverages (Do Not Include Tax)......... A.
Phone r 1
Total ;exempt Food Beverage Sales B. Q
BROOKSHIRE GOLF CLUB Net Taxable Sales (Subtract Line H from Line A)— C. f U
CARMEL UTILITIES y( ten/
Taxpayer ID Number For Tax Period Tax Due I% of Line C).._......____ D. I I F
Collection Allowance (.73% of Line D) tj J
0003120155 009 0 MAY 2011 Do Not Use this Line ifthe Payment is Late d
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)"
Hamilton JUN 30 2Di1 Useth islineonlifretumisfiledlate G.
in terest Rate is 9
Adjustments (An explanation must be aitached) H.
lriltltltltritlll ,tliirrllrrillirtlll Total Amount Due (Total Lines F and G plus or minus H) I• I D �(y
INDIANA DEPARTMENT OF REVENUE
P.0• BOX 7229
INDIANAPOLIS,IN 46207 -7229
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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.
J
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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Z? D (O�j. 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
,�Af,e.
Ale A t J
Sign r
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund