211545 08/06/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $193.78
INDIANAPOLIS IN 46207 CHECK NUMBER: 211545
CHECK DATE: 8/6/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 7/31 1 193 . 78 GOLF F & B 7/12
$lglld[Ilred f6�C��u E'v�4"
`yT 6
+'
FAB-1,03 0811
19 ' '4,d
I declare u !!er p nalfies of perjury that this is a true,correct and corn e turn.
Date 1p Phone ')(� �I Total Sales of Food&Beverages(Do Not Include Tax)......... A. o
BROOKSHIRE GOLF CLUB
Total Exempt Food&Beverage Sales................................... B.
CARM EL UTILITIES Net Taxable Sales(Subtract Line B from Line A)................... C. 0 b,
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. 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
�j C.
AUG 30 2012 Net Tax Due(Subtract Line E from Line D)............................ F. 1 3 1}
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��I�I�I�In�l�l�lulnll�n�llnl�il Total Amount Due(Total Lines F and G plus or minus H) 1. i O
INDIANA DEPARTMENT OF REVENUE
P.0• BOX 7229
INDIANAPOLIS,IN 46207-7229
08000011355495101025292911597073120 1206
�7�T AuWociaed rxfry 7 n7
FAB-103 0811
<>Siguature /F�4ry=d.'}„>'S'�.�#,�S �-�'
I dec ee der 2t perjury that this is a true,correct and co ete-etum. � � �� D S
Date b - Phone 3(, t N�1 I' F Total Sales of Food&Beverages(Do Not Include Tax)......... A. IrJ,
���LLL
BROOKSHIRE GOLF CLUB Total Exempt Food&Beverage Sales................................... B.
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A)................... C. l � 5 g O
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. 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.
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.
Inl�l�l�ln�l�l�l�tlnllnnll��l�ll Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE v
P.0• BOX 7229
INDIANAPOLIS,IN 46207-7229
08000011355 4950010252900015970731201206
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.
In/� Payee V v OA/ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5 ' x 3. 7
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
ON ACCOUNT OF APPROPRIATION FOR
emit TtvLc/- /JO
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
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
AM 14 &4
ignature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund