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Home My WebLink About208178 04/24/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE i CARMEL, INDIANA 46032 ENFORCEMENT DIVISION -AUDIT MS 104 CHECK AMOUNT: $532.20 w or �0 100 N SENATE AVE IGCN 241 CHECK NUMBER: 208178 INDIANAPOLIS IN 46204 -2253 CHECK DATE: 4/24/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 GOLF -2009 532.20 2009 GOLF AUDIT AR -80 PROPOSED ASSESSMENT 1 SF 43430 (Rev. 7/2011) INDIANA DEPARTMENT OF REVENUE REFER TO THIS NUMBER ON ANY CONTACT WITH THE DEPARTMENT -00- Liability Number: 2009 03299478 Notice Number: 12037310905 Date Issued: 04/23/2012 Taxpayer TID: 0003120155 004 FI D: 35- 6000972 Form Number: ST -103 1200091456561 1111111111611111IIIII IIIII9111111111IIIII11111IIIII IIIII11111IIIII IIIII11111IIII1111 GA30 385280 -06 CARMEL UTILITIES DLN: 385280 -06 BROOKSHIRE GOLF CLUB Account ID: 113554949 1 CARMEL CIVIC SQ Liability Period: December 31, 2009 CARMEL, IN 46032 Tax Type: Sales IMMEDIATE ACTION REQUIRED: A review of your Indiana Sales tax for the tax period December 31, 2009 shows you may owe 532.20, including penalty and interest. YOU MUST TAKE ACTION IMMEDIATELY TO RESOLVE THIS TAX DEBT. You must pay the amount owed no later than June 22, 2012, or you may protest this tax assessment within 60 days (by the due date listed here and below). If you fail to do either, this tax debt will continue to accrue interest and could ultimately convert into a tax warrant for collection action. To pay your tax bill online, please visit: www.epay.in.gov today. Or call our office at (317)233 -5172 to make a payment arrangement or for questions. If you have closed your business, please visit www.in.gov /dor /3749.htm to complete the official paperwork immediately. Thank you for your immediate attention to this matter. *SEE REVERSE SIDE FOR IMPORTANT DETAILS AND MAILING ADDRESSES. EXPLANATION OF TAX DUE FOR PERIOD ENDING December 31, 2009 Original Tax (Sales) 464.06 Penalty 0.00 Interest Daily Amount $0.05 68.14 Amount you owe Due Date: June 22, 2012 532.20 Please place your Taxpayer TID number (see above) on your check (made payable to Indiana Department of Revenue) and mail with the form provided below: CARMEL UTILITIES Taxpayer TID: 0003120155 004 Liability Number: 2009 03299478 Notice Number: 12037310905 AMO UNT Due Date: June 22, 2012 PAID Indiana Dept. of Revenue PO Box 1028 AMOUNT YOU OWE: 532.20 Indianapolis, IN 46206 -1028 IIIII„ IIIIII�IIIIIIIIIIIIIII 01000312015500200903299478070000000053220 Continued from previous page. Notice Number: 12037310905 Issued 04/23/2012 EXPLANATION OF TAX DUE FOR: December 31, 2009 CARMEL UTILITIES THIS IS A PROPOSED ASSESSMENT FOR THE PERIOD SHOWN ON THE ENCLOSED AUDIT INTEREST CANNOT BE ABATED/WAIVED BY THE DEPARTMENT. IC 6- 8.1 -10 -1. A DESCRIPTION OF THE COLLECTION PROCESS, OPTIONS FOR PAYMENT, AND INSTRUCTIONS TO PROTEST A NOTICE OF PROPOSED ASSESSMENT ARE INCLUDED IN THE DEPARTMENT'S PUBLICATION A (THE COLLECTION PROCESS). THIS DOCUMENT IS AVAILABLE THROUGH OUR WEB SITE AT THE FOLLOWING ADDRESS: HTTP: //W W W.I N. GOWDOR /REFERENCE /FILES /M ISC— PUB —A. PD F INTEREST IS CALCULATED ON ALL UNPAID TAXES BEGINNING WITH THE DUE DATE OF THE RETURN AND ENDING THE DATE LIABILITY IS PAID IN FULL. INTEREST RATES ARE AS FOLLOWS: 2011 -9 2010 -4 2009 -7 2008 -7 2007 -5 2006 -4 2005 -3 2004 -4 2003 -6 2001-2002=8%,1996-2000=7%,1995-6%,1993-1994=7%,1992-8%, 1989- 1991 =10 %,1988 =9 %,1987 =8 %,1986 =10% 1984- 1985 =12 1983 =13 %,1982 =17 %,1981= 12'/o,1978- 1980= 8 %,1950- 1977 =6% PER IC 6- 8.1 -10 -1. If you have any questions about WHY this tax is due, If you have any questions about PAYMENT of this billing, you may call between 8:00 AM and 4:30 PM Monday you may call or write between 8:00 AM and 4:30 PM through Friday Eastern Standard Time or write to: Monday through Friday Eastern Standard Time: Indiana Goverment Center North Indiana Dept. of Revenue Audit Divsion Mail Stop 104 CUSTOMER CONTACT DIVISION Attn: Shelly Gardner (317)234 -3752 PO Box 1028 Indianapolis, IN 46204 Indianapolis, IN 46206 -1028 (317)232 -2165 �o INDIANA DEPARTMENT OF REVENUE SUMMARY Page 1 of 6 Pages (Rev. 03/01) Control No.: 385280 -06 Tax Type: Taxpayer: FID Number: RST Carmel Utilities 35- 6000972 T Report Brookshire Golf Club TID Number Audit 0003120155 -004 Btu. Code: Address Streamlined Nbr: 713900 12120 Brookshire P kwy County City State Zip Code: Representative Phone Number Hamilton Carmel, IN 46032 (317 846 -7431 Mailing Address: Representative E -mail Address Same As Above plisterpcarmel.in.gov Period 12/31/2009 12/31/2010 Statute Date 12/31/2012 12/31/2013 Adjustments to Tax Amounts Sales Tax $464.06 $0.00 Use Tax $0.00 $0.00 Less:Collection Allowance Adj. $0.00 $0.00 Adjustment To Tax Amount 1 $464.06 $0.00 Penalty 0 a Interest- L g o Totals of 0 Report Total ,D P Representative Name Title: This Report Was Discussed With (if different) Pam Lister Office Administrator Auditor's Signature and Number: Date of Completion Rita Scott 0198 2/13/2012 Remarks: A Food and Beverage (FAB) audit was conducted for calendar years 2009 and 2010. This review resulted in no proposed audit adjustment. Power of Attorney None INDIANA DEPARTMENT OF REVENUE ADJUSTMENT RECAP-TAX AMOUNT Carmel Utilities Page: 2) Sales Use Control Nbr.: 385280-06 Year Ending Year Ending Page Grand T6tals Code Citations Tax Issues 12/31/2009 12/31/2010 References Per Citation Taxable Banquet Room Rental and Food and Beverage Sales Reported 45 IAC 2.2-8-12 as Exem 6 464.06 4 464�0 -1 I 464.06 0.001 4640 Indiana Department of Revenue Explanation of Adjustments Page: 3 Control No.: 385280 -06 CARMEL UTILITIES DBA BROOKSHIRE GOLF CLUB I. Business Description Brookshire Golf Club is a municipal golf course owned by the City of Carmel. It has an on -site pro shop and banquet facility. Brookshire Golf Club charges green fees and provides various items for rental, including golf carts. U. Explanation of Sales and Use Tax An Indiana tax compliance audit was conducted for calendar years 2009 and 2010. The audit included a review of transactions made by the golf club. The audit procedures and results are detailed as follows: Sales Tax Indiana sales tax returns (Form ST -103) for Brookshire Golf Club are filed with the Indiana Department of Revenue to report and remit sales tax on its taxable transactions. T The revenue reported as taxable include pro shop sales, cart and banquet room rentals, and food and beverage sales. An examination was conducted to verify the accuracy and the completeness of Form ST -103 filed for calendar 2009 and 2010. In support of its sales tax filings, the taxpayer provided the trial balance for periods ending 12/31/2008, 12/31/2009, and 12/31/2010, and daily sales reports. The review resulted in the following noncompliance and an assessment of additional sales tax as discussed below: Inclusion of Tax in Selling Price During the period under review, the audit found that sales tax is not separately stated from the selling price for merchandise sold in the pro shop as well as cart and banquet room rentals and food and beverage sales. Since the inclusion of tax is in the selling price, the tax is `backed out" and remitted to the Indiana Department of Revenue. The Indiana gross retail sales tax regulation requires sellers to add the sales tax to the selling price and to separately state the sales tax on all receipts or slips, rent receipts, charge tickets, and invoices. Brookshire Golf Club has been put on notice that the inclusion of tax in the selling price of property is incorrect. Furthermore, Brookshire has been instructed that the sales tax remitted on the Indiana sales tax returns must be calculated on the invoiced selling price. Indiana Departrnent of Revenue Explanation of Adjustments Page: 4 Control No.: 385280 -06 Taxable Banquet Room Rental and Food and Beverage Sales Reported as Exempt The audit found in calendar year 2009, some room rentals and food and beverage sales was included in the exempt revenue in error. In other instances, some food and beverage transactions claimed as exempt from tax were not documented. The audit is imposing sales tax on transactions detailed on page five (5) of the audit report where sales tax was not collected and not supported with a valid exemption certificate as required by 45 IAC 2- 2 -8 -12. The tax effect of this adjustment is as follows Authority: 45 1A 2.2 -8 -12 Period Ending Sales Tax 12/31 /2009 6,629.37 464.06 (From Page 5) (To Page 2) Use Tax Pursuant to Information Bulletin #4 (August 11, 2011) and IC 6- 2.5 -5 -44 effective July 1, 2007 provides that transactions of city or town are exempt from the sales /use tax if the property acquired is used in the operation of a municipal golf course. Carmel Utilities INDIANA DEPARTMENT OF REVENUE Page: 5 Sales Jnvoices Fiscal /Calendar Year Ending 12/31/2009 Additional Taxable Sales Sub- Totaled By: Citation Control Number: 385280 -06 Date Reference Account Customer Item Description Amount 07/06/2009 Chanel Cunningham Food and Beverage Purchases, Rm $290.00 Rental and Equip Rental 08/04/2009 Christ the King Food and Beverage Purchases $641.00 06/18/2009 International Association of Plastics Food and Beverage Purchases $1.765.31 Distribution 06/10/2009 Jane Pierce Banquet Room Rental $200.00 10/09/2009 Leah Brezette Room Rental $100.00 08/10/2009 Lyle Spaugh Food and Beverage Purchases $992.46 09/21/2009 Minority Engineers Food and Beverage Purchases Need $306.60 Exemption 04/13/2009 No Documentation Non Food and Beverage Sales $150.00 04/24/2009 No Documentation Non Food and Beverage Sales $100.00 04/27/2009 No Documentation Non Food and Beverage Sales $200.00 05/11/2009 No Documentation Non Food and Beverage Sales $200.00 05/18/2009 No Documentation Non Food and Beverage Sales $39.00 06/23/2009 No Documentation Non Food and Beverage Sales $325.00 07/14/2009 Rocky Singh Food and Beverage Purchases $480.00 07/23/2009 Rocky Singh Food and Beverage Purchases $400.00 09/14/2009 YETI Food and Beverage Purchases $440.00 45 IAC 2.2 -8 -12 SubTotals: $6,629.37 Tax Due/(Refund) Per SubTotal To Page 2: $464.06 i 1 HUKFM q0 TKW3lAgHG AYIAIW 1401TAajgXl jo V OITAM%M (04 .VM) 8QA mtOi aM828£ .ov I OlwO3 I I I I b9fniop nB io n9 BgxBf odf tfd �hw o 6 noiiBmih 2idf to o2ogiuq 9dT bfm �ofolgmoo fmd ad no itEgb ov ni io f ibuB blod odf bofm k mod ad 9vifBfno2oigoi 2a IofIB zfomjw4 b 2ogoiq IBnd oMo gmffiw III b5fthi od lliw Iopgxpf odf f Bdf .fnomjmpG A Xd Io uft bowmim f 2Bd ioitBm I 2fIn29I 9df f29foiq XBin I9XBgXBf o& jfi 5m22922B b92ogoiq B m zdlum n ol mfl xo gaH odf 8mb1B89I n ol miolm bob ivoiq 2Bd ionimBX9 odT .I- Z -I.8 -a �I fliiw 9onBbiooaB >It (.fi>fd.066fl o2IB o02) .zoiub000iq 2IMgB 9df Xd b9ld mWo bmAoi B to Ills lo XfIB to limb oM mum n off im m 9df l fl I- Q -I.8-d I bw 93n&oo3B m Wob 9fb IB9ggB pm i5 yBgxBf A jOppo d 2m off buWgxo ad Iomm m 9df gni*lwodas 2i nXEgXBf odf ,wolod gnigi2 Y8 9 fulko3 f on 29ob 97Ufgi2 .IoggBlo zt bfm noiiG8iiti vni I f ibuB b19ft 9dflo elm b92ogoiq A dfiw I mmwTp 1 I 1 9IId6O$l2el1 xa 9msYli5 squT 9f6Q 9 kfo A m' qmT 91f ►T bns omZ Wnhq s o w s ale Carmel Utilities 12120 Brookshire Pkwy Carmel, IN 46032 Trudy Gredy 100 N Senate Ave Rm -N241 Indianapolis IN 46204 Date: April 19, 2012 RE: Indiana tax audit questionnaire for the recent audit completed by: Rita Scott 1. When making the appointment, did the examiner ask if it was a convenient time to discuss the audit and did the examiner ask you if you had any concerns regarding the audit? Disagree 0 1 2 3 4 Strongly Agree 2. When making the appointment, did the examiner explain what records, tax types, and tax years that was to be examined and how long the audit was expected to take? Disagree 0 1 2 3 4 Strongly Agree 3. Before or during the audit process, did the examiner describe the procedures to be utilized? Disagree 0 1 2 3 4 0 Strongly Agree 4. Were the examiner's work hours compatible with the hours of your business? Disagree 0 1 2 3 4 Strongly Agree If not, what hours did the auditor normally work? 5. Was the audit conducted in a professional and businesslike manner? Disagree 0 1 2 3 4 65) Strongly Agree 6. Please think for a moment about fairness, but only in terms of how you feel the Indiana Department of Revenue has treated you and NOT in terms of how you feel about Indiana tax laws. Do you think you were treated fairly? Disagree 0 1 2 3 4 Strongly Agree 7. Was the examiner knowledgeable of Indiana tax laws as they apply to business? Disagree 0 1 2 3 4 Strongly Agree 8. If audit adjustments were made, were they fully explained at the conclusion of the udit? NA Disagree 0 1 2 3 4 Strongly Agree 9. Did the examiner address all of your questions in regards to the proposed assess nt? NA Disagree 0 1 2 3 4 Strongly Agree 10. Did the examiner explain the appeal procedures? NA Disagree 0 1 2 3 4 Strongly Agree 11. Was the final audit report clear and easily understandable? Disagree 0 1 2 3 4 Strongly Agree 12. What was the result of your audit? (Circle which applies) C !fT Refund No Change Audit wary s 7 9 Please explain all responses of 3 or less below and add any other information you wish to share with us about the examiner and/or how the audit was conducted. Comments Name TAIL Date: o j R. INDIANA DEPARTMENT OF REVENUE Page 1 of 6 Pages It (Reu.,03701) 3'85280 -Q6 ontrol No Tax Typc Tiixpaver': 'w r FID Number s RST. Carmel'Utilities 35- 6000972- Type Repori•: BTOt?kshire.'Goli Club t` TID Number Audit i 0003 -004 Address Streamlined Nbr 713 12120 Brookshif6�1 i :County "City State "Zip: Code Representative Phone`Number Hamilton) Carmel; IN .46032 (3 g Address Represefi ta tive E matl'Addre"s Ma lin s a Same As Above' plister(@carmel.in,.gov Eenod 12/31%2009= a' sI2/3`l/2010,; Stafufe;Date 12/3`1%20,12 ,12/3'I720l3 J Adjustments toIdx Amounts Sales. Tax $464 :06 $0.00 i Use'T $0:00 $0.00 Less. Collection Allowance Adj. $0.00 $0:00 1. v Ad usfinent T,o Tax Amount; $464.06 $0.00 ;.wP..enalty,-- .��.,,M�,.,.,� ir d :Interest, g 7 t j Totals. Re ort Total S� r. Repiescatative 1Tam'e'& Title: Ibis Report Was Discussed'With•(if different) Pam Lister- Office'-Administrator Audttors�Si'�nature- and .Date of Completion. Rita Scott 2/13720/2 ##t l 98 Remarks: and Beverage (FAB) :audit' was conducted. for calendar years 2009 'and 2010. This review:. A Foo "d a. resulted in no proposed audit adjustment. Powd,, of Attomey ,None'., �i IndianatDepartment of Revenue r p Adjustments Ex lanatlon of A'd'us Pager 3 Control,No:: 385280 -06 CARMELOTI ATIES. 'DRABROOKSH1lLZE GOLF 'CLUB L,B'usiness. Description Brookshire.Golf:Club is.,a_:rnunicipal golf course.owned :by the .City orf Carmel It'has on -site ,pro :shop and banquet: facility:: Brookshire' Golf Club changes green,.fees and. provides various items for rental, including golf carts.: H_Fxplanation of Sales and Use Tax i Ari= Indiana tax compliance audit wasfconducted for calendar years'2009 and 2010 The audit included a,feview.oftransactions'irade by the +golf club: The audit procedures And results are: detailed as follows; Sales Tax Indiana sales tax returns (Form ST 103) for Brookshire,:GolfClub are filed with the lndianaEDepartment of Revenue to report and remit sales -tax on its taxable transactions The revenue reported as taxabi'e�mclud'e pro shop sales cart and banquet room,rentals, ;and�food'-andTbeverage sales An examirtation:was >conducted to °verify the accuracy and the completeness of Form ST 103 filedc for calendar 2009 and 2010. In support:of its. sales tax film s .the tax g payer provided the trial,balance for- periods ending l2 /3 f/2008,, 12%31/2009, and' 12/31/201:0,, and daily sales reports. The review resulted in the following noncompliance and an assessment" of�additionaI', sales tax as discussed. below: 1ncl"usi6n of Tax. in Selling,. Price; Dwru•►g..fhe that, sales taxis not separately stated perio d under;review,, the: audit found from the selling;price for, merchandise sold in thelpro shop as well as.cartand banquet room rentals and .food e.sa ince and beveragles: S the inclusion of tax is'in the selling price, the tax is'`backedl,out" and remitted to the Indiana Department of Revenue. The Indiana gross retail'sales tax regulation requires sellers to addahe sales tax to the "selling and'to separately state the sales:tax on all receipts or slip s;,rent receipts, charge wickets, and -invoices: 'Brookshire. Golf 'Club has been put notice that the inclusion. of tax,in,`the selling price of property is incorrect. Furthermore, Brookshire ,has, een instructed thatthe sales tax remitte'd.,on the Indiana. sales fax returns must be i calculate'd.on the invoiced selling price. is Carme uti lhes r INDIANA DEPARTMENT OF R1 V,ENUE Page:' 5 Additional`Taxable'Sales Sub_daz Year.Ending T2/3:1l2009 Control`Nuinber: 7 385286 -06.: es Invoices Sal t isea aen TotaledBy,Citarion Date Reference Account# Customer 1 ltem Descrip Amount ,07/06/2009 Chanel Cunningham g G gham ,r °Food'and e Purchases, Rm $290.00 Rental and Equip.Rental y. 08/104,/2009• Christ the Kmg Food'<aiid Bey erage Pui chases $641.00' 06/18/2009 International Association of Plastics Food and ,Beverage,P,urchases $`1,765.3'1 Distribution 06%10/2009 Jane' Pierce Banquet. Rental t „'$200.00 1- t 10 110912009 Leah Brezette Room Rental $100.00 08110/2009 'Lyle-Spaugh:, Food and,Beverage,Purchases_ $992.46 09/21/2009 Nlinority'Eggneers Food and Beverage Purchases -Need $306:60 Eaemppori. 04/1312009 _'Nd,Docurnenteation NoAood:and'BeverageSales $150.00 04/24/2009 No-Documentation Non,food,and $1(1b:00 04/27/2009 No Docufnentatron Non Food and Beverage Sales 05/11/2009 NgDocumentation Non Food ,.and Beverage Sales. $200.00 b5/11 oc 009. No Dumentation Non Food. and B everage Sales $39.00- 06/23/2009 No Documentation Non and Beverage Sales $325:00 y 07/ =14/2009.... Roc( .iSin Food and•Beverage Purchases $480.00 07/23/2009 Rocky Singtii Food: and'Beverage, :Purchas'es' $400.00 09/1'4/2009 .YETI Food andBei!erage'Purchases $440:00' 45 IAC 1.24=12 SubTotals; $6,629;37 TaxDue/(Itefund)'Per SubTofal: ToP.'age 2 S464.06 f f,.,, *.fix..• w x s. •..w r.� ,s f, OPQSED ASSES SMENT.. AR -80 SF•43430 +(ReJ.7/2011) INDIANA OF REVENUE REFER TO THIS NUMBER ON:ANY c6NTACT'wITH THE DEPARTMENT Liability Number: 2009 03299478' Notice Number 12Q373109Q5 Date'ls"sued: 04/23/2012 Taxpayer TID: 0003120155- 004 FI D: 35z,-6Q Form ,Number.,: ST- iiO3". `120009 1456561 GA30 385280 -06 CARMEL UTILITIES DLN 385280 06 BROOK SHIRE GOLF CLUB Account ID. 1 1 C ARM EL CIVIC'SQ Liabilrt Period: December 31 209• Liability 'Period:, 0 CARMEL, IN 46032 lax Type: Sales IMMEDIATE ACTION REG1U'IRED "A review "of your lndiana'Sales,fax foi .th'e tax'peirod D 6n 31, 2009 sliow §.you may �E owe 20, I a6d 1 interest.a.YOU'.MUST TAKE IMMEDIATELY 'TO.RESOLVETHIS;TAX,_DEBT. You is must pay the no;later than Jurie 22, 201;2; or`you may protest this tax ass'es'sment. With in daysE(by -the due i� date listed -here and below). If, fail to do either,'this° °tax debt continue t accrue,:intere`st and could ultimately convert into a, tax warranffor�collection action. To pay your tax °bill on'lihe, please visit: www.epay:in.goV today. Or call our office at (317)233- 5172 to make a payment: arrangement,orJo'r °questions.; if you have closed ,your business, please +visit Www.in.gov /dor /3749 ;htm to complete the official paperwork immediately. Thank you for your`immediate attention to this matter:, ""`SEE'.REVERSE'SIDE FOR.. o IMPORTANT DETAILS AND MAILING ADDRESSES."* EXPLANATION OF TAX DUE FO ENDING. Decernber 31, 2009 I OrlginaliTax� (Sales) '464 06. 0.00 1_ Penalty Interest ,Daily Amount, $0.05 68.14 Amount you,owe Due, Date: June 22 „2012. 4 532.20 Please place your Taxpayer: T.ID"number (see above),onyour check (made payable to Indiana Department of Revenue) and mail with the form provided below: LL CARMEL UTILITIES I Taxpayer TI D: 0003/20155 004 Liability Number: 2009-03299478 Notice Number: 1203731 =:0905 t AMOUNT Due Date June 22,'201'2 a 'PAID i a Indiana,'Dept. of'Revehue' PO Box 1.028 AMOUNT YOU OWE: 532:20 Indianapolis IN 46206 1 II,I11'IIII 1111 "IIIIIIIIIII IIIIIIIIII,IIIIIIII I.II IIII III IIII tr m 0,100'0'3120155002 ,09032994780700'000,000,53220 V 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 04/23/12 12037310905 Sales Tax $532.20 1 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 Indiana Department of Revenue IN SUM OF P.O. Box 1028 Indianapolis, IN 46206 -1028 $532.20 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1207 12037310905 3 V7 b $532.20 1 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 Monday, April 23, 2012 Director, Brookshir holf Club Title Cost distribution ledger classification if claim paid motor vehicle highway fund 133438 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1.800- 891 -6499 Marion County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22 -4 -19.6, IC 4 -1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ REPORTING MONTH MAR, 2012 CARMEL IN 46032 -2584 NET CHARGES $4 POSTING DATE APR 06, 2012 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report any information which could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END I CLAIM R WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING I ACO CHARGED THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTINg14ONTH 03/12 266 -55 -4159 M CALLAHAN (L 01/19/13 REG 03/08/12 03/03/12 181.00 266 -55 -4159 M CALLAHAN 1�(VU Ina 01/19/13 REG 03/15/12 03/10/12 h 133.00 i 266 -55 -4159 M CALLAHAN �9' 01/19/13 REG 03/27/12 03/17/12 266 -55 -4159 M CALLAHAN 01 /19/13 REG 03/27/12 03/24/12 215.00 303 -46 -3718 D M TRICE 11/24/12 REG 03/05/12 03/03/12 242.00 303 -46 -3718 D M TRICE 11/24/12 REG 03/12/12 03/10/12 1�/ 242.00 Up'� 303 -46 -3718 D M TRICE 11/24/12 REG 03/19/12 03/17/12 176.00 304 -80 -0401 C VEACH O 02/16/13 REG 03/04/12 03/03/12 Cj 333.00 .305 -60 -3857 D D NORRIS V 01/08/11 EB 03/04/12 03/03/12 390.00 305 -60 -3857 D D NORRIS pC1, 01/08/11 EB 03/15/12 03/10/12 390.00 305 -60 -3857 D D NORRIS 01/08/11 EB 03/21/12 03/17/12 390.00 t• 305 -60 -3857 D D NORRIS 01/08/11 EB 03/27/12 03/24/12 390.00 308 -58 -7615 T D MYERS 07/14/ REG 0 3/04/12 03/03/12 389.84.E 316 -46 -8217 M D CALVERT 12%29/12 REG 05/ 1 12 02/25/12 224.00 316 -46 -8217 M D CALVERT 12/29/12 REG 03/08/12 03/03/12 224.00 I_ 316 -46 -8217 M D CALVERT �!l�\ 12/29/12 REG 03/15/12 03/10/12 224.00 W 316 -46 -8217 M D CALVERT 12/29/12 REG 03/20/12 03/17/12 224.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 03/12 4,494.84 REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 01/09 312 -98 -2537 M EDWARDS 10/31/09 REG 03/26/12 12/27/08 74.74CR �L r TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 01/09 74.74CR TOTAL AMOUNT OF NET CHARGES 4,420.10 CqCj An V) in the ACQ column denbtdsF&2h i AWOM MtibW6f another business. 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 03/31/12 Statement $1,560.00 1 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. Indiana Department of Workforce Development ALLOWED 20 IN SUM OF Benefit Administration, 10 N. Senate Ave Indianapolis, IN 46204 -2277 $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Mayor's Office PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1160 Statement 41- 100.00 $1,560.00 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 Saturda April 21, 2012 Mayor Title Cost distribution ledger classification if claim paid motor vehicle highway fund