HomeMy WebLinkAbout208548 05/02/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $111.51
INDIANAPOLIS IN 46207
CHECK NUMBER: 208548
CHECK DATE: 5/212012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -GOLF 1 111.51 F& B -GOLF 4/12
Auwi.d a AB-103 0 811
X m Sign""
I declare under enalties of perjury that this is a -e correct and complete u
Date I a Phone �I� 1 2 I�— F Total Sales of Food &Beverages (Do Not Include Tax)......... A.
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales (Subtract Line B from Line A) C.
CARMEL UTILITIES 3
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D. lJ'
APR 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
MAY 30 2012 Net Tax Due (Subtract Line E from Line D) F. I I I I
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 Carmel *The 2012 Annual Interest Rate is 4%
Adjustments (An explanation must be attached) H.
I ttitltltltttlllllllltltlltttlittltll Total Amount Due (Total Lines F and G plus or minus 11) 1. l l �b
INDIANA DEPARTMENT OF REVENUE
P•0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
Illttllllttltlllillllllttlltttlttlllllillllllllllllllltlllttll 080000113554951010252929115970430201210
X Authorized F A B -10 3 0 811
Signature I
1 declare u er enalties of perjury that this is a true, correct an comp!
-7 J
Date phone 1 I Total Sales of Food Beverages (Do Not Include Tax) A. I I r
Total Exempt Food Beverage Sales B.
BROOKSHIRE GOLF CLUB
CARMEL UTILITIES Net Taxable Sales (Subtract Line B from Line A) C.
Taxpayer ID Number For Tax Period Tax Due (I %of Line C) D. 3
APR 2012 Collection Allowance (.73% of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line ifthe Payment is Late E.
MAY 30 2012 Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of 55 or 10% of Line F (Plus Interest)*
County /Town Use this line only ifremm is filed late
Check if Amended Hami l ton *The 2012 Annual interest Rate is 4 G.
Adjustments (An explanation must be attached) H
Il lllllllllllllllllllllllllltllllllll
INDIANA DEPARTMENT OF REVENUE Total Amount Due (Total Lines F and G plus or minus H) 1. I I
P•0. BOX 7229
INDIANAPOLIS,IN 46207 -7229
I111111111111111111111111 II 11111 111I1111 III I1111 illlll1111 11 1 1
080000113554950010252900015970430201210
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.
M Payee
Y A Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) 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
IN SUM OF
C)
i
ON ACCOUNT OF APPROPRIATION FOR
c l, o t 00 4ep,
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
20
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund