HomeMy WebLinkAbout205122 01/04/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 SYSTEM SERVICES CHECK AMOUNT: $34.10
PO BOX 6197
CHECK NUMBER: 205122
INDIANAPOLIS IN 46206 -6197
CHECK DATE: 1/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 12/11 -2 34.10 GOLF -F &B 12/11
r 9 F a r D f
Aa,hn., /gyp G ,d AB-103 0 810
X Sigweure d
I declare nder penalties ol'perjury that this is a true. correct and complete n n.
l 2 Total Sales c Food Beverages (Do Not Include Tax A.
Date_ Phone l 1
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB]
I 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•
Collection Allowance L73°/ of Line D)
0003120155 004 0 DEC 2011
Do Not Use this Line if the Payment is Late E.
County /Torn Due on or Before Net Tax Due (Subtract Line 1 from Line D) F.
Penalty is Greater of $5 or 10io of Line F (Plus Interest)"
Carmel JAN 30 2012 Use this line only ifretum is filed late G.
"Tlte 2011 Annual Interest Rate is 7 "G.
Adjustments (An explanation must be attached) H. I `r
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Total Amount Due (Total Lines F and G plus or minus H) I.
I INDIANA DEPARTMENT OF REVENUE 1
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7 7
III III IIIIIIIIIII II II III II II111111IIIII III11111 1111111 0 8 0 0 0 0 1 1 3 5 5 4 9 5 1 0 1 0 2 5 2 9 2 p 1 1 1 5 9 7 1 2 3 1 2 0 1 1 1 0
P'
F,AB -103 0810
V nwuori,ede 4 R
11 s gnamrc q� ,9
I declare u de enaities ol'perjury that this is a true co an (onlpl*i turn.
Date `T Phone I l F Total Sales of Food Beverages (Do Not Include Tax) A.
Total Exempt Food Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales ISubtmci Line B from Line A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due 11% of LineC) D.
Collection Allowance (.73% of Line D)
0003120155 004 0 DEC 2011 Do Not Use this Line ifthe Payment is Laic E.
County /Town Due on or Before Net Tax Due (Subtract Line Efrom Line D) F.
Penalty is Greater of $5 or to% of Line F (Plus Interest)
Hami 1 Lon JAN 30 2012 Use this line only ifretum is filed late G.
*The 2011 Annual liner" Rate is
Adjustments (An explanation must be attached) }I.
I I I I I I I I I I I I n I u I l I I l I n 1 1111 u l I i l Total Amount Due (Total Lines F and G plus or minus H) I. r
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229 try
IIIIIIIILI IIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIII loll IIIIIIIIIIIII 080000113554950010252900015971231201110
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
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
IN SUM OF
0 X
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
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund