210715 07/16/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 Po eox 7229 CHECK AMOUNT: $211.00
INDIANAPOLIS IN 46207 CHECK NUMBER: 210715
CHECK DATE: 7/16/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 063012 F & B 211 . 00 GOLF-F & B 6/30
) .r+
/ ( s ����1.., FAB-103 0811
AA�7�7 Authonzed {! a ^a�y
I declare under penalttHS of pet7ury.t�h7at this t true',c'o)rtect and complete rettuti� I C
�I Phone (I Total Sales of Food&Beverages(Do Not Include Tax)......... A. J
Date
Total Exempt Food&Beverage Sales.... B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B from Line A)................... C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(I%of Line C).................................................. D.
JUN 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 l I co
JUL 30 2012 Net Tax Due(Subtract Line E from Line D)............................
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town 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.
1 1111 itltinlltlutilnlillililultll Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P•0- BOX 7229
INDIANAPOLIS,IN 46207-7229
' Itlttlt 11111111111111111111[1]lttlllttl11l11ttttltll,111111111 080000113554951,01025292911,5970630201207
ON
� 1! FAB-103 0811
XAUtM1orized f /'r
S�guatuce � �
I declare under penalties of pedury that this is a,-u,correct and complete re
Date Phone �I l I �--� F Total Sales of Food&Beverages(Do Not Include Tax)......... A. �� I 5�
Total Exempt Food&Beverage Sales................................... B.
BROOKSHIRE GOLF CLUB a� .5 3
Net Taxable Saes(Subtract Line B from Line A)................... C.
CARMEL UTILITIES 15 CJ
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. D.
JUN 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 1 ` l G n
JUL 30 2012 Net Tax Due(Subtract Line E from Line D)............................ E. rJ'� I
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this tine only if return is filed late..................................... G.
Check if Amended Hamilton *The 2012 Annual Interest Rate is 4%
Adjustments(An explanation must be attached)...................... H.
I u I t 1 t I t I u t 111 n 111/1111 u tills 1111 Total Amount Due(Total Lines F and G plus or minus H) 1. ( l .C, o
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
11111111111111111111111111111111111111111111111111111111 111111 080000113554950010252900015970630201207
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.
Payee
r l,� Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) /
(L�
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.
'J ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
D � 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund