HomeMy WebLinkAbout204118 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $40.46
INDIANAPOLIS IN 46207 CHECK NUMBER: 204118
CHECK DATE: 12/612011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F B -NOV 2 40.46 GOLF F B -NOV 2011
Amhwirrd FAB 3 0810
X signature r G J h £2 �fi
I declare under pengl to pegs ry hat th is a true, correct and complete l turn. f O I
3 5 l l Total Sales of Food &Beverages (Do Not Include 7'ax)......... A. 4
Date Phone 1
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB 0 5 4
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES d
Taxpayer ID Number For Tax Period Tax Due 0% 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.
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. `i 0
Penalty is Greater of S5 or 10% of Line F (Plus Interest)'
Hamilton DEC 30 2011 Use this line only ifretum is filed late G.
*The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached) H,
I rtlrlrlrlrrrllttllrrrlrrltrrllrtrlll Total Amount Due (Total Lines F and G plus or minus H) I. 4 v
INDIANA DEPARTMENT OF REVENUE
P.O- BOX 7229
INDIANAPOLIS,IN 46207 -7229
Illrtlrlltrrtlrlllr�rlrrrllrrrlrrlrirtl�llrlrrrrlrllllrrllrrrl 08000011355 4950010252900015971130201100
X s,gaaturr s �-.FAB —10 3 0 810
a
I declare under penalties ofperjury that thisiss1a true, correct and comp ret
Date I� 5 O (I Phone si 5�
1 I Total Sales of Food Beverages (Do Not Include Tax)......... A. I) n i S
d a
BROOKSHIRE GOLF CLUB Total Exempt Food Beverage Sales B.
CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C. 0 �1 4
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. "l 0 �C
0003120155 009 0 NOV 2011 Collection Allowance (.73 %of Line D) q
Do Not Use this Line if the Payment is Late E. 3
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. v
Penalty is Greater of S5 or 10 %of Line F (Plus Interest)*
Carmel DEC 30 2011 Use this line only ifretum is filed late G
The _011 Annual Interest Rate is 9%
Itrlrlrlrirrrlltrllrrrlrrlrrrllrrrlll
Adjustments (An explanation must be attached) H
INDIANA DEPARTMENT OF REVENUE Total Amount Due (Total Lines F and G plus or minus H) I.
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Irlrt 0800001135549510102529291159 71130201100
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 1
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.
ALLOWED 20
—&Ve, rque IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
M G
Board Members
PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund