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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 I.I..I�II����I, III.., LIIII���I��IIII�IIILItI�II�ILIt�ll��ll 08000 0113554951010252929115971231201110 i 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 I. I.. I�II�t��I�IIL�IIt��II��II ,eI�I��I�II�I��tII�IItL�llrt�i 0800001' 135549500102529000159 71231201110 i' I I 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