212468 09/11/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 SYSTEM SERVICES CHECK AMOUNT: $197.69
PO BOX 6197 CHECK NUMBER: 212468
INDIANAPOLIS IN 46206-6197
CHECK DATE: 9/1112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 8/12 2 197 . 69 F & B TAX-GOLF 8/12
C24,FAB-103 0811 y
D FTotal Sales of Food&Beverages(Do Not Include Tax)......... A.
Total Exempt Food&Beverage Sales................................... B.
Net Taxable Sales(Subtract Line B from Line A)................... C. (I�
Tax Due(I%of Line C).................................................. D. l I I I
Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late............................ E.
Net Tax Due(Subtract Line E from Line D)............................ F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
Use this Ime only if return is filed l ate..................................... 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 II) I• 1 q —7*
0800001,1355495 101025292911,5970831201210
I
FAB-1D3 0811
3 j
F Total Sales of Food&Beverages(Do Not Include Tax)......... A. 1 I I I
`f Total Exempt Food&Beverage Sales................................... B. �} i
Net Taxable Sales(Subtract Line B from Line A)................... C. q,? 1 1�
Tax Due(t%of Line C).................................................. D. (
I I
Collection Allowance(.73%of Line D) ,1
Do Not Use this Line if the Payment is Late............................ E. L�
:e
Net Tax Due(Subtract Line E from Line D)............................ F.
Penalty is Greater of S5 or 10%of Line F(Plus Interest)*
Use this line only if retum is filed l ate..................................... 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 11)
08000011,3554950010252900015970831201210
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.
P yee
�C1 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 $
o
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