HomeMy WebLinkAbout204117 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
q 0 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
s4� CARMEL, INDIANA 46032 PO Box 7229 CHECK AMOUNT: $40.46
INDIANAPOLIS IN 46207 CHECK NUMBER: 204117
CHECK DATE: 12/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F B -NOV 1 40.46 GOLF F B -NOV 2011
f
f r Y
FAB —10 3 0 810
A gruitu "rd r/ A
S�gnarure t r e J' t i r r ��,�F'�
I declare under pena)t as nTperJu y that 61,Mss true, correct and etnuplete f urn. D l
Date Phone �J/ Total Sates of Food Beverages (Do Not Include Tax)......... A.
u Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB 4 r i 5 g 4
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (1% of Line C) D.
0003120155 009 0 NOV 2011
Collection Allowance (.73 %of Line D) O
Do Not Use this Line ifthe Payment is Late E. rt
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. 4 0
Penalty is Greater of $5 or 10 %of Line F (Plus Interest)"
Hamilton DEC 30 2011 Use till's line only ifremrn is filed late G.
'The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached)............. H.
lulrltltl ,r,ll,lllnrlrrintllutlll Total Amount Due (Total Lines F and G plus or minus H) I. 4
INDIANA DEPARTMENT OF REVENUE
P-0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
1, Ittltllrrt, lrllltr, Lttilrttlrrltl ttLll,IrtrtltlltL,lltr,l 08000017, 355 4950010252900015971130201100
Aarherned ''k f
FAB 3
Si ar� V 0 810
1 declare under Penalties o1'perjury that this is a true. correct and complete ret
Date lo( I Phone S I "I f" g Total Sales of Food Beverages (Do Not Include Tax)......... A. dr D 9 S r
BROOKSHIRE GOLF CLUB Total Fxempt Food Beverage Sales B.
CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C. l0 �ff I 4
Taxpayer ID Num ber For Tax Period Tax Due (l of Line C) t
0003120155 00.9 0 NOV 2011 Collection Allowance (.73%of Line D) q
Do Not Use this Line ifthe Payment is Late E, I /0
County /To 4
wn Due on or Before Net Tax Due (Subtract Line E from Line D)......... F. 1 IC
Penalty is Greater of$5 or 10% of Line F (Plus Interest)
Carmel DEC 30 2011 Use this line only ifreium is filed late G
*The 20Ll Annual Interest Rateis9
Adjustments (An explanation must be attached) H
Irtlrltlrlrnlln ,ln,ll
INDIANA DEPARTMENT OF REVENUE Total Amount Due (Total Lines F and G plus or minus B) I. O
P-O- BOX 7229
INDIANAPOLIS,IN 46207 -7229
1, 1 r, lrll tt„!,!! L„ L, t lt ,IrrlJrrLllrLr 080000113554951010252929115971130201100
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.
Paye
`✓�Q Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or
r
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 -W 4AwQ0.
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
i
Title
Cost distribution ledger classification if 67
claim paid motor vehicle highway fund