209901 06/19/2012 a CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $190.45
CARMEL, INDIANA 46032 PO BOX 7229
_off a� INDIANAPOLIS IN 46207 CHECK NUMBER: 209901
CHECK DATE: 6/1912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F& B -5/12 1 190.45 F& B -GOLF 5/12
FAB -103 0811
Total Sales of Food Beverages (Do Not Include Tax) A. I 8
V
7 F Total Exempt Food Beverage Sales B.
Net Taxable Sales (Subtract Line B from Line A) C. l I I 40
Tax Due (1% of Line C)
Collection Allowance (.73% of Line D)
Do Not Use this Line if the Payment is Late g, I
Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of S5 or 10% of Line F (Plus Interest)' i 1 C Use this line only if retum is filed late G.
'The 2012 Annual Interest Rate is 4%
Adjustments (An explanation must be attached) H.
Total Amount Due (Total Lines F and G plus or minus FI) L C
080000113554950010252900015970531201209
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))
t
V j m ma �y h d L
qD. 4s—
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
LNJk
o a
ON ACCOUNT OF APPROPRIATION FOR
6 ,01 f o o
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
0
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund