HomeMy WebLinkAbout179491 11/18/2009 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
?4f� CHECK AMOUNT: $113.58
s, +l CARMEL, INDIANA 46032 SYSTEM SERVICES
PO Box 6197 CHECK NUMBER: 179491
INDIANAPOLIS IN 46206 -6197
CHECK DATE: 11/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
!_O1 5023990 113.58 F B -GOLF 10/09
FAB -103 0808 l
f
4u wri,ed s 17
I I a
X s ig mn,rr Total Sales of Food Beverages (Do Not Include Tax) A.
Ideclareantler penalties ofperjury that this is a true, correct and complete r
y( 2 1 {(J Total Exempt Food &Beverage Sales B.
S
Dare II PhoneA� �J1I_ F
Nei Taxable Sales (Subtract Line B from Line A) C. I I 5 7 O
BROOKSHIRE GOLF CLUB Tax Due (I %of Line D.
CARMEL UTILITIES Collection Allowance (.73% ofLine D)
Taxpayer ID Number For Tax Period Do Not Use this Line ifthe Payment isLate E.
000312 0155 004 0 OCT 2009
Net Tax Due (Subtract Line E from Line D) F.
County /Town Due on or Before Penalty is Greater of $5or10 %ofLineF (Plus interest)*
Carmel NOV 30 2009 Use this line only if retumis filed late G.
'The 7009 Annual Interest Rate is 7%
Adjustments (An explanation must be attached) H. C�
Ir ,lrlrl,llnllu,Ilrrllrlllnrlrinl Total Amount Due (Total Lines F and G plus or minus H) I.$ 1
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
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I J 111111 1111 1 201
i
FAB -103 0808 +rr r
�l
X sg�awn o Total Sales of Food &Beverages (Do Not Include Tax) A.
I declare under penaihes of perjury that this is u true, correct and cmtrphte re r
I Inx Total Exempt Food Beverage Sales B.
Date I� Lv Phone s I” -2 �U
4 F
Net Taxable Sales (Subtract Line B from Line A) C.
BROOKSHIRE GOLF CLUB Tax Due( 1% ofl- ineC).._ D.
CARMEL UTILITIES Collection Allowance (.73 %ofLineD) L �7
Taxpayer ID Number For Tax Period Do Not Use this Line ifihe Payment isLate
0003120155 004 0 OCT 2009
Net Tax Due (Subtract Line E from Line D) F. +v
j County /Town Due on or Before Penalty is Greater of$5 or 10% ofLine F (Plus Interest)*
Hamilton NOV 30 2009 Use this line only ifretumis filed late G.
*The 7009 Annual Interest Rate is 7%
Adjustments (An explanation must be attached).. H.
I
Inlrlrlrlrnllnrllr ,lnlll,nlrlrrl
Total Amount Due (Total Lines F and Ci plus or minus l[1
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I, IrrfrlLr, Jrllllr, III rllrrr ill Ill fill ill I11rrL11111111 „rl 04000011355495001 ,025103120091130200907
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 1�. Cog
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
W
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6 M- 00
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