HomeMy WebLinkAbout205128 01/04/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
0 CHECK AMOUNT: $34.10
CARMEL, INDIANA 46032 Po eox 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 205128
CHECK DATE: 114/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 12/11 -1 34.10 GOLF -F B TAX 12/11
XAmor ai,rd 4 I AB —10 3 0 810
SignaNre
Ideclare nder peoalnes afperjurytat thisi� rue. correct and
—,plot
m,e ty n. f F
(J J F "total Sales 000d Beverages (Do Not Include Tax)......... A. II l C
Dale ph
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A).-. C.
CARMEL UTILITIES ,1 f
Taxpayer ID Number For Tax Period 'fax Due 1% of Line Q.— D.
i
0003720155 004 0 DEC 2011 Collection Allowance (.73 %of Line D)
Do Not Use this Line iCihe Payment is Late E.
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F. t D
Penalty is Greater of S5 or 10% of Line F (Plus Imerest)*
Carmel JAN 30 2012 Use this line only ifretum is filed late G.
'The 20t 1 Annual Interest Rate
Adjustments (An explanation must be attached)_ g,
Total Amount Due (Total Lines E and G plus or minus Fl) I. (j
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
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FAB -103 0810,
X Aulhari,ed v
Signs Nye i
I declare u der enalties ol'perjury thut this is n [rue. correct and co mpleyv`'#e n. s
hJ Total Sales of Food Beverages (Do Not Include Tax)...._... A. L. I l 1 s-
Date j�. 1 phone ✓I�� I
BROOKSHIRE GOLF CLUB
Total Exempt Food &Beverage Sales B.
CARMEL UTILITIES
Net Taxable Sales (Subtract ne RIfrom Line A)............... C. Q
j 2 f
Taxpayer ID Number For Tax Period Tax Due (I of Line C 3 "1 D. 34
Collection Allowance (.73% of Line D)
0003120155 004 0 DEC 2011 1
Do Not Use this Line if the Payment is Late E.
County /Town Due on or Before Net'Fax Due (Subtract Line E from Line D) F.
Penalty is Greaterof55 or 10 %of Line F (Plus Interest)*
Hamilton JAN 30 2012 Use this line only ifretum is filed la te G,
°The 2011 Annual hnerest Rate is 9 I
Adjustments (An explanation mustibe attached) H.
Inlll�l�l�lltln�ll�ll�nrrtllnitll Total Amount Due (Total Lines F and 6 plus or minus Fl) I. tt
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
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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 invoic (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
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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund