HomeMy WebLinkAbout211544 08/06/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
0 ) CHECK AMOUNT: $193.78
CARMEL, INDIANA 46032 SYSTEM SERVICES
PO BOX 6197 CHECK NUMBER: 211544
INDIANAPOLIS IN 46206-6197
CHECK DATE: 8/612012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 7/31 2 193 . 78 F & B-GOLF 7/12
Authorized ( Rh' �- ��., .�� -k F A B—10 3 0 811
Signatur
I declare /er p nalties of perjury that this is a true,correct and corn ed turn.
Date Phone I Total Sales of Food&Beverages(Do Not Include Tax)......... A. 1 0 1t7 V
Total Exempt Food&Beverage Sales................................... B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B from Line A)................... C.
CARMEL UTILITIES �f
Taxpayer ID Number For Tax Period Tax Due(1%ofLine Q.................................................. D.
JUL 2012 Collection Allowance(.73%of Line D)
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late................... E. L-3
AUG 30 2012 Net Tax Due(Subtract Line E from Line D)............................ F.
Penalty is Greater of S5 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.
Itiltl�lil��tltlil�tl a Ilt n tllttltll Q :�
Total Amount Due(Total Lines F and G plus or minus FI) I.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
0800007,13554951010252929 115970731201206
�a n
_'
far m FAB-103 0811
XAu[honzed J± ��r� q.,k�7
I dec ee 'der
fperjury that this is a[rue,correct and co et eturn. L� O
Date Phone ]5'1 l`-51 Il r Total Sales of Food&Beverages(Do Not Include Tax)......... A. f 1 tV
Total Exempt Food&Beverage Sales................................... B.
BROOKSHIRE GOLF CLUB I_
Net Taxable Sales(Subtract Line B from Line A)................... C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. D. 1
JUL 2012 Collection Allowance(.73%of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late............................ E. , 3
AUG 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 line only if return is filed late..................................... G. l
Check if Amended Hamilton *The 2012 Annual Interest Rate is 4%
Adjustments(An explanation must be attached)...................... H.
lul�l�l�lu�l�ltinit�lln�tll��l�ll Total Amount Due(Total Lines F and G plus or minus Il) 1.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
080000113554950010252900015970731201206
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.
►l} Payee n
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 $
78
ON ACCOUNT OF APPROPRIATION FOR
fitnd ,--10o A
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
l� 3. 78 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