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CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $192.25
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 198886
CHECK DATE: 715/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2 192.25 F B TAX -6/11
Aarhod W FAB —10 3 0 810 e- X signaNre
I declare u d e r p a pepu t a r a ru and complete 1. 1 I a
Date
��✓IJ I I Phon I a r 21 4 I Total Sales of Food Beverages (Do Not Include Tax)......... A. kJ C✓
Total Exempt Food &Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C. 0 2—
CARMEL UTILITIES 13 (o
Taxpayer ID Number For Tax Period Tax Due I of Line C) D.
Collection Allowance (.73 %of Line D) I 4 1
0003120155 004 0 JUN 2011 Do Not Use this Line ifthe Payment is I_ ate E.
County /Town Due on or Before
Net Tax Due (Subtract Line E from Line D) F. 1
a
Penalty is Greater of $5 or 10% of Line P (Plus Interest)"
Carmel AUG 01 2011 Use this line only if return is filed late G.
'The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached) H
Irrlrlrlrltrrlrlrrillrrllirr�llrirlll Total Amount Due (Total Lines F and G plus or minus H) 1. Z
INDIANA DEPARTMENT OF REVENUE
P-0- BOX 7229
INDIANAPOLIS,IN 46207 -7229
I�I��IrII����IrIII�r�I���IIrr�I��I�I�rIrIlrlrr�rl�Ilrllrllrrrl 0800001, 13554951010252929115970630201106
Wit
—i d FAB —10 3 0 810
X signature
I declare under penalties o1'perjury that this is a true, correct and corn le re 1rn. I n
Date
Phone I 1 I Z Total Sales of Food &Beverages (Do Not Include Tax) A. L
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line II from Line A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D.
0003120155 004 0 JUN 2011 Collection Allowance (.73% ofLine D) I I
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. Z
Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Hamilton AUG 01 2011 Use this line only ifretum is filed late G.
'The 2011 Amoral Interest Rate is 9
Adjustments (An explanation must be attached) H.
I�il�lrlrlrrrlrlrrrllrrllrrr�llrrilll Total Amount Due (Total Lines F and G plus or minus H) 1. 2—
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
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Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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.
Pa ye
VA,L"p
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
t 1
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.
1 20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
4AItn
1, t IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
C—W Fund uo
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
20
oa
Ar
`I Signature
(J
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund