HomeMy WebLinkAbout200220 08/10/2011 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: $166.93
INDIANAPOLIS IN 46207 CHECK NUMBER: 200220
CHECK DATE: 8/10/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF F B 2 166.93 GOLF F B 7/11
X sis— red
y FAB -103 0810
S�gnayre
i decly a dcr CIA= perjury that this is a [rue, correct and cone t eturn.
hone i Total Sales of Food Beverages (Do Not include Tax) A. b
Date P
Total Exempt Food Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C. 8 S IO
CARMEL UTILITIES 1
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. I 8 Y
Collection Allowance (.73 %of Line D)
0003120155 009 0 JUL 2011 Do Not Use this Line ifthe Payment is Late E, a2
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. fP
Penalty is Greater of$5 or 10 %of Line F (Plus Interest)*
Hamilton AUG 30 2011 Use this line only ifrewm is filed late G.
*The 1 011 Annaal interest Rate is 9%
Adjustments (An explanation must be attached) H. q
InIrIrlrllrrl tglgtlglggtllggglll Total Amount Due (Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE l
P.0• BOX 7229
INDIANAPOLIS,IN 46207 -7229
IgigglrllgggrlgllllrglrrglLrllgllglrglrl lglgglrlrllllggllrggl 080000113554950010252900015970731201105
r
X A. a°,`,ed AB —103 0 810
I declare tinier penalties ol'perjury that this is a true, correct and complet et Q
Date Phone �j F Total Sales of Food Beverages (Do Not include Tax) A.
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. I {Q a
0003120155 009 0 JUL 2011 Collection Allowance (.73% of Line D)
Do Not Use this Line if the Payment is La te E. I
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. q-3
Penalty is GreaterofS5 or 10 %of Line F (Plus Interest)*
Carmel AUG 30 2011 Use this line only ifretum is riled late G
*The 2011 Annuai Interest Rate is 9%
Adjustments (An explanation must be attached) H.
lulrlrlrlggglglglrglggirlrgglln ,lll Total Amount Due (7btai Lines F and G plus or minus H) L Gj
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
IrLrlrll, gE, IrIIIIrgLggllggglrllglgglrllllgggglrllllggliggrl 080000113554951010252929115970731201105
Prescribed by Stare 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
U 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.
�1 ALLOWED 20
I V IN SUM OF
o
&�2 q3
ON ACCOUNT OF APPROPRIATION FOR
6" 1 &jo Awio/=o-
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoices 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
F�
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
