208114 04/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 SYSTEM SERVICES CHECK AMOUNT: $56.37
PO BOX 6197 CHECK NUMBER: 208114
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INDIANAPOLIS IN 46206 -6197
CHECK DATE: 4/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B —GOLF 4 56.37 F& B —GOLF 3/12
i
XAut N r .F c s�,>;.z t 44 t F A B —10 3 0 811
1 de tare and r penalties of perjury that this is a true, correct and completer wn. n I
Date Total Sales of Food &Beverages (Do Not Include Tax) A.
5� OY
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB C p,
Net Taxable Sales (Subtract Line B from Line A) C. t� �2-
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. ,5
MAR 2012 Collection Allowance (.73% of Line D) i
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E
APR 30 2012 Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
County /Town Use this line only ifretum is filed late G.
Check if Amended Hamilton 'The 2012 Annual Interest Rate is 4%
Adjustments (An explanation must be attached) H
Itiltliltl nnlinliintllfnliulill Total Amount Due (Total Lines F and G plus or minus H) 1. 5 3
INDIANA DEPARTMENT OF REVENUE
P.0- BOX 7229
INDIANAPOLIS,IN 46207 -7229
080000113554950010252900015970331201201
7
C
F p f of r
X A °th, i F A B —10 3
Signature 2... 0 811
I declate nder penalties of perjury that this is a true, correct and co o etum.
Date 5�, S 7 J i
Phone Total Sales of Food &Beverages (Do Not Include Tax)......... A.
BROOKSHIRE GOLF CLUB 1A' Total Exempt Food Beverage Sales B.
CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C.
T axpayer ID Number For Tax Period C J
Tax Due (1% of Line C) D. J (C
MAR 2012 Collection Allowance (.73% of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E.
APR 30 2012 Net Tax Due (Subtract Line E from Line D) F. J 7
County /Town Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Use this line only if return is filed late G.
Check if Amended Carmel 'The 2012 Annual Interest Rate is 4
Adjustments (An explanation must be attached) H.
I��I�I�I�In��ll��l�ln�ll�nll��l�ll
Total Amount Due (Total Lines F and G plus or minus H) 1,
INDIANA DEPARTMENT OF REVENUE 7
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
080000113554951010252929115970331201201
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
6 Purchase Order No.
Terms
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