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174595 07/15/2009
CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $413.38 INDIANAPOLIS IN 46207 CHECK NUMBER: 174595 t L CHECK DATE: 7115/2009 DEPARTMENT ACCO UNT T PO NUM INVOICE NUMBER AM D ESCRIPTION 101 5023990 F 13-GOLF 06/09 FAB -103 0808 WHOM V Auttprized Q s,s,rai Total Sales of Food Beverages (Do Not Include Tax)._...... A. Z V 2 (o 0 i I declare under perti a complete retur Total Exempt Food Beverage Sales B. I I I �4~ phonek J I `t� hh Net Taxable Sales (Subtract Line R from Line A) C. S O V BROOKSHIRE GOLF CLUB Tax Due (I %of Line C) D. CARMEL UTILITIES Collection Allowance (.73% ofLine D) 52 Taxpayer ID Number For Tax Period Do Not Use this Line if the Payment is Late 0003120155 004 0 JUN 2009 6 1 Net Tax Due 1 Subtrap Line E from Line D) F. I Penalty is Greater of $5 or 10 %of Line F (Plus Interest)• County /Town Due on or Before Use this line only ifretumis filed late. G. Carmel JUL 30 2009 *The 2009 Annual Interest Rate is 7% Adjustments (An explanation must be attached) H. Irrltlrlrltr ,lrlrnllurllllrlrirlul Total Amount Due (Total Lines F and G plus orminusH) 1 �•lo INDIANA DEPARTMENT OF REVENUE P•0• BOX 7229 INDIANAPOLIS,IN 46207 -7229 Irlrrlrllrurlrlllrrrlurllrrrinlrinlrllrlrnrlrllrlrrllurl 040 00011355495101025063020090730200900 FAB -10 _0808 r ligg 3 Sig"" red n A Sigrrewe Total Sales of Food &Beverages (Do Not Include Tax) A. 0 2 1 I declare under penalties ofperjury that this is a a b correctand corn turn. bete `1 ©"1 Phone k '7 I Total Exempt Food &Beverage Sales B. Net Taxable Sales (Subtract Line H from Line A) C. 0 Z 0 V BROOKSHIRE GOLF CLUB Tax Due 0 %of Line C) D. 2 o g Z� CARMEL UTILITIES Collection Allowance {.73 %ofLineDI S Taxpayer ID Number For Tax Period Do Not Use this Line ifthe Payment is Late E. 4 0003120155 004 0 JUN 2009 b Net Tax Due (Subtract Line E from Line D)..,.. F. County /Town Due on or Before Penalty isG reaierof $5or10 %ofLineF (Plus Interest)* Hamilton JUL 30 2009 Use this line only ifreturnis filed late G. -The 2009 Annual Interest Rate is 7% Adjustments (An explanation must be attached) H. Irrlrlrlrluelrinrllrnllllnrlrlrrl Total Amount Due (Total Lines F and G plus or minus H) I.$ INDIANA DEPARTMENT OF REVENUE P -0• BOX 7229 INDIANAPOLIS,IN 46207 -7229 r Itl ulrllrrrrlrlllrrrlrrrllrrrin lrlrrltllrinnlrlltlnllnrl 0 4000011355 495001025063020090730200905 Prescribed by.5tat2 Board of Accounts 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. n Payeenn ro Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) v R 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. a W a tt ALLOWED 20 IN SUM OF 7 )L� s 4:3 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