208134 04/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7226 CHECK AMOUNT: $56.37
INDIANAPOLIS IN 46207 CHECK NUMBER: 208134
CHECK DATE: 4/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 3 56.37 F& B -GOLF 3/12
Xs;� to F A B —10 3 0 811
I declare and penalties o f tha is a [rue, cor and complete.ret�. n I
Date -L� hone 1 Total Sales of Food &Beverages (Do Not Include Tax) A. UX
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES 7
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. 5 p
MAR 2012 Collection Allowance (.73% of Line D)
Do Not Use this Line if the Payment is late E
0003120155 004 0 Due on or Before
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 ifrettnn is filed late G.
'The 2012 Annual Interest Rate is 4%
Check if Amended Hamilton
Adjustments (An explanation must be attached) H.
t tltliltllt�tlli�ltlitilltt�lltilill Total Amount Due (Total Lines F and G plus or minus H) I. 6
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
080000113554950010252900015970331201201
6 .q
X AathoriaW f, f F k d N F A B —10 3
i. 1: a_ a, a .0 0 811
Signature
1 declare nder penalties of perjury that this is a true, correct and compietefretum.
�'1 5 7a
Date Phone t$1 Total Sales of Food &Beverages (Do Not Include Tax)......... A.
BROOKSHIRE GOLF CLUB Total Exempt Food Beverage Sales B. i
CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C.
Taxpayer ID Number For Tax Period Tax Due %of Line 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.
County /Town Penalty is Greater of $5 or 10% of Line F (Plus Interest)*
Use this line only if return is filed late G.
Ch @Ck if Amended Carmel `The 2012 Annual Interest Rate is 4%
n l l l l n l l n l l n l l n l l u i l l Adjustments (An explanation must be attached) H.
Total Amount Due (Total Lines F and G plus or rums H) I.
INDIANA DEPARTMENT OF REVENUE 7
P.O. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I I��I�IL���IJ
080000113554951010252929115970331201201
Prescribed by State 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.
Payee
/V_mU�__ Purchase Order No.
L
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
�0_b s 61V X
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