HomeMy WebLinkAbout177067 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $333.14
CARMEL. INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 177067
CHECK DATE: 9/1512009
!JEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
h`'01 5023990 F B 09/09 333.14 F& B 09/09
FAB -103 f 08018
r
X nt,ehoroea
Sig- Total Sales of Food Beverages (Do Not Include Tax) A.
Ideclure under penalties ofperj ury that this isutrue, correct and conrpte et n.
j� Total Exempt Food Beverage Sales B.
Date "7 Phone it(�)_ 71- z iL f f o q 3
1 Net Taxable Sales (Subtract. Line B f Line A) C.
BROOKSHIRE GOLF CLUB Tax Due (1% ofLine C) D. 10 r
CARMEL UTILITIES Collection Allowance (.73% ofLine D) Z Z
Taxpayer ID Number For Tax Period Do Not Uset his Line l ftlte Payment isLate E.
171003120155 004 0 AUG 2009 6
Net Tax Due (Subtract Line E from Line D) F. (G'
Penalty is Greater of $5 or 10 %of Line F (Plus Interest)*
County /Town Due on or Before Use this line onl if
only is filed
Carmel SEP 30 2009 dlt G.
*The 2009 Annual interest Rate is 7
Adjustments (An explanation must be attached) H
i
I Ir�l�l�lrllttLll�t�l�rll�llrr�l�l�tl S to 5�
I Total Amount Due (Total Lines F and G plus or minus M) 1.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I�IrrIrlltt�Jtllir ,rlrlltl���rilllrl�tll�rtl 040000 113554951 011025083120090930202929
i
FAB -103 0808
X .4uthorived
s;
Total Sales of Food &Beverages (Do Not Include Tax) A. I Tj v`
I declare under penalties orperjury that this is a true, correct and complete n. y t
�J "j Total Exempt Food &Beverage Sales B.
y
Date 1 -I -09 Phone4 P A� d '7 I V F
Net Taxable Sales (Subtract Line B from Line A)................... C.
BROOKSHIRE GOLF CLUB Tax Due (I %of Line Q....................................................... D. I `1
CARMEL UTILITIES Collection Allowance (.73%afLineD) ZZ
Taxpayer ID !Number For Tax Period Do Not Use this Line ifthe Paymeni is Late B.
0003120155 004 0 AUG 2009
Net Tax Due (Subtract Line E from Line D) F Yw�
Penalty is Grewerof$5 or 10 %oCLine F (Plus Interest)*
County /Town Due on 0r Before Use this line only ifretumisfiledlate G.
Hamilton $EP 30 P009 *The 2009 Annual Interest Rate is 7%
Adjustments (An explanation must be attached) H.
Irtl tlrltltnlrllrtrlrtlltllrttltltrl Total Amount Due (Total Lines F and G plus or minus 11) L$ 7
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
i Irl��itllrrrtltlllt�rlrr�ILt�lt�l�l��lrfl�lrtttl�ll 04000011355495 001025083120090930200903
Prescribed by State Board of AccaTmts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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))
At
X33.
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 11 ,QL IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
6w1w
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
p 3, f 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
F 20
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund