170905 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
t, ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 Po eox 7229 CHECK AMOUNT: $24.40
INDIANAPOLIS IN 46207 CHECK NUMBER: 170905
CHECK DATE: 4116/2009
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
101 5023990 24.40 F B TAX 03/09 -GOLF
iy
I
FAB -103 0808 r 1
X Aud yy
sign, ngri r se Total Sales of food Beverages (Do Not Include Tax)......... A. l -7 CJ IG
Ideclare under penalties ofperjurythatthis is a hue, correct and conrple t
r� --7 Total Exempt Food &Beverage Salts. B.
Date 14 1 E1� F j Phone h l�� p 2�
Net'faxable Sales (Subtract Line B from Line A) C.
BROOKSHIRE GOLF CLUB Tax Due 0% ofLine Q D. 2- y
CARMEL UTILITIES Collection Allowance (.73% ol'Une D) d G;Gt
Taxpayer ID Number For Tax Period Do Not Use this Line ifthe Payment is Late E-
00 0312 0155 004 0 MAR 2009 F I -2--
Net Tax Due (Subtract Line E from Line D) 1
County /Town Due on or Before Penalty is Greater of $5 or 10% ofLine F (Plus Interest)*
e
I Hamilton APR 30 2 Use this line only ifrournisFrledlate G.
'The 2009 Annual Interest Rate is 7%
J Adjustments (An explanation must be attached) H.
I ,lriul Total Amount Due (Total Lines F and G plus or minus M L$
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Irlrrlrllrtrrlrll lrrrlrtrllrlrlrrltlrrlrllrlrrrrlrllrirril a 11 04000011355495001025033120090430200901
FAB -103 08_08 111 r
uftri, d
signer Total Sales of Food Beverages (Do Not Include' fax)......... A. I 7
I declare under penalties afperjury that tins is a true, correct and complete r r
F Total Exempt Food &Beverage Sales B. L L
Date V Phone p as 1 I I
Net Taxable Sales (Subtract Line B from Line A) C.
BROOKSHIRE GOLF CLUB Tax Due I% afLineC) 1
CARMEL UTILITIES Collection Allowance (.73% ofLine D) O
Taxpayer ID Number For Tax Period Do Not Use this Line ifthe Payment is Late E. j
0003120155 004 MAR 2009
Net Tax Due (Subtract Line E from Line D) F.
County /Town Due on or Before Penalty is Greaterof $5or10 %ofLineF (Plus interest)*
Carmel APR 30 2009 Use this line only ifretumis filed late G.
"The 2009 Annual Interest Rule is 7%.
Adjustments (An explanation must be att ached) H.
1 Inlllrlrinnllrrlrlllnrllrrrlrlrrl Total Amount Due (Total Lines F and G plus or minus H) 1.$
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 462 07 -7229
Irlrrlril urrlrlllrnlrrrl lurlulrlrririirlr1r11r1111rrllrrrl 040000 111355495101025033120090430200907
Prescribed by Stale Board of Accounts City Form No. 201 (Rev. 1995)
x 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
L �j k a Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(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
MA
l
IN SUM OF
1
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOU DEPT. her Y 1 hb certify that the attached invoices 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund