HomeMy WebLinkAbout203221 10/27/2011 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPARTMENT OF REVENUE
CHECK AMOUNT: $183.93
CARMEL, INDIANA 46032 Po eox 7229
INDIANAPOLIS, IN 46207 -7229 CHECK NUMBER: 203221
CHECK DATE: 10127/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 183.93FOOD BEV -GOLF 9/11
B -10 3 0 810
X signaNre
I declare un j er penalties of perjury that thi is a true. c correct and compl i re m. Q
Date l o 1 phone 1 —�-f� I Z`�V 1 Total Sales of F ood 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 M s oZ
Taxpayer ID Number For Tax Period TaxDue(I %of LineC)........._ D.
0003120155 004 0 SEP 2011 Collection Allowance (.73% ofLine D)
Do Not Use this Line if the Payment is Late E_ 1
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D)_ F.
Penalty is Greater of S5 or 10% of Line F (Plus Interest)*
Carmel OCT 31 2011 Use this line only ifretum is filed late G. 1
'The2011 Amual Interest Rate is 9%
d Adjustments (An explanation must be attached) f{,
l u l 111111111111 I I n 111 n I I I I I 11 I I I I I Total Amount Due (Total Lines F and G plus or minus H) 8
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
111111,11111111111111L 1111111111111 ,1111111111111111111 0$0000113554951171 ❑25292911597 ❑9302011 ❑7
f
6
X���i ,1 FAB -10 3 0810
I declare penalties o p
ferjury thut this is a true. correct and completer l
Date re i S 11 Phone '55 �1 24 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. 1 l
CARMEL UTILITIES i g 02
Taxpayer ID Number For Tax Period Tax Due (1% of Line C) D.
Collection Allowance (.73 %of Line D)
00037 20155 004 0 SEP 2011 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.
Penalty is Greatercf or 10 %of Line F (Plus Interest)*
Hamilton OCT_ 31 2011 Use this line only ifretum is Sled late G. ll
'The 2011 Annual Interest Rate is 9%
I I I I I I I I I I I I III Adjustments (An explanation must be attached) H.
11 1 1 1 i 11 IIII 11 III III Total Amount Due (Total Lines F and G plus or minus H) 1• 1 D 3
INDIANA DEPARTMENT OF REVENUE
P -0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Ill. 111111111,11111 IIII, 111 Ill 1, 11111LIIiL1111111111AlIIll 08000011355495001 ❑2529❑❑ ❑1597093 ❑201107
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.
Payee
4 L/ L Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
F VqZ
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
i s 1 4to �-t 7
ON ACCOUNT OF APPROPRIATION FOR
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
F
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund