HomeMy WebLinkAbout210716 07/16/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO Box 7226 CHECK AMOUNT: $211.00
INDIANAPOLIS IN 46207
CHECK NUMBER: 210716
CHECK DATE: 7/1612012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 6/12 F & B 211 . 00 GOLF F & B 6/12
FAB-103 0811
Authorized Q't
Signature g F
a o ✓
I declare�u+nder penalti8's of per)ury that this t true,correct and complete r�etu�rn � + � 5 G `�
Date /1 I {� Phone ( 7� ��f ! Total Sales of Food&Beverages(Do Not Include Tax)......... A. 1 ) y,
1� Total Exempt Food&Beverage Sales................................... B.
BROOKSHIRE GOLF CLUB C; 63
Net Taxable Sales(Subtract Line B from Line A)................... C. �
CARMEL UTILITIES 21 C'�1j
Taxpayer ID Number For Tax Period Tax Due(I%of Line .................................................. D.
JUN 2012 Collection Allowance(.73%of Line D) G5
Do Not Use this Line if the Payment is Late,.......................... E.
0003120155 004 0 Due on or Before
JUL 30 2012 Net Tax Due(Subtract Line E from Line D)............................ F. I
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.
il 111 1 1111111 1 111 11 1 111 I 1 111 1111 11 11 I Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
III1111111111111111111111111 III III 1111111111111111 111111111111 08000011,355495101,0252929115970630201207
0
FAB-1,03 0811
XAUthorizedf �•
signature �,1��`t Ce,
I declare under penalties of pedury that this is a true,correct and complete re
Date Phone �I1 71 ( Total Sales of Food&Beverages(Do Not Include Tax)......... A. c +
Total Exempt Food&Beverage Sales................................... B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B from Line A)................... C.
CARMEL UTILITIES I <J
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. D.
JUN 2012 Collection Allowance(.73%of Line D) �_ r
Do Not Use this Line if the Payment is Late............................ E. J
0003120155 004 0 Due on or Before I I C'e�
JUL 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 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.
1111111 I I 1 1111111,111111111111 1 11111 I Total Amount Due(Total Lines F and G plus or minus H) I. n( -(,'
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
fI111111111111111i11111111111111111111111111111111111111111111 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
Ci lc'o ^� V . Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(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 $
D; ,
S GM 4on
ON ACCOUNT OF APPROPRIATION FOR
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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund