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Home My WebLink About206939 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $2.32 CARMEL, INDIANA 46032 PO BOX 7229 INDIANAPOLIS IN 46207 CHECK NUMBER: 206939 CHECK DATE: 3/1312012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 2/1 -GOLF 2.32 F B -GOLF 2/12 Food and Beverage Tax or County Supplemental Food and Beverage Tax (Instructions for completing Form FAB -103) The following instructions are to assist you in completing Form FAB°-103. The instructions are valid for this form only. A. Total Sales Enter the total receipts from food and beverage sales. Do not include sales tax or food and beverage tax on this line. B. Total Exempt Sales Enter the total exempt food and beverage sales. This figure cannot be greater than the amount on Line A. C. Net Taxable Sales Subtract Line 13 from Line A. This figure must never be greater than Line A- D. Tax Due Multiply Line C by the county tax rate listed on your return. If there is an entry on this line, there must be entries on Line A and Line C- E. Discount (Collection Allowance) Use this line only if your return is postmarked on or before the due date. The discount is available only when the payment is remitted timely. For further information, please refer to this Web site: www.in.gov /dor /3618.htm F. Net Tax Due Subtract Line E from Line D. G. Penaltylinterest Due A payment made after the due date is subject to penalty and interest on the total on Line D. The penalty is 10 percent of the total on Line D, or $5, whichever is greater. To calculate interest, multiply the amount due by the annual interest rate and divide the result by 365. Multiply that result by the number of days the payment is late. Interest is computed from the due date of the return to the date payment is made. Interest is not computed on the penalty. H. Adjustments Adjustments can be an overpayment or underpayment. If Line H has a negative entry, use a negative sign. A negative adjustment must have an explanation attached or the adjustment will be disallowed. This line cannot be greater than the amount due. 1. Total Amount Due Add Lines F and G plus or minus Line H. Include this amount with your return. Please do not send cash. Make check payable (in U.S. funds) to the Indiana Department of Revenue. 6 i Y s FAB -103 0811 l g ia.�.re Vn aRn.n er�myien aie�s. i..e w„gie ^.rewm. Date 3 Phone Z Total Sates of Food Beverages (Do Not Include Tax) A. BROOKSHIRE GOLF CLUB Total Exempt Food Beverage Sales B. CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C. Taxpayer ID Number For Tax Period Tax Due (1 l° of Line C) D. Collection Allowance (.73% of Line D) Do Not Use this Line if the Payment is Late E. z 0003120155 004 0 Due on or Before 70 1 Z- Net Tax Due (Subtract Line E from Line D).. F. G County /Town Penalty is Greater of S5 or 10% of Line F (Plus Interest)' Use this line only if return is filed late., G. CheCk if Amended Hamilton 29000 'The 2012 Annual Interest Rate is 4 111 Adjustments (An explanation must be at tached H. 1 11 1 �lI1I1II11111F11l1l��I11�I1f�1�I Total Amount Due (Total Lines F and G plus or minus H) I, Z --2 INDIANA DEPARTMENT OF REVENUE P.O. BOX 7229 INDIANAPOLIS, IN 46207 -7229 IIIII�I�I11!l a �l tll'1II�IIIIIII{IIIII!lII IIIIIIIIIIIlII 080000113554950010252900015940131201209 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. I Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoices) or bill(s)) 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 r �Ju IN SUM OF ON ACCOUNT OF APPROPRIATION FOR e�- Kb kpp 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 a. 20 5 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund