HomeMy WebLinkAbout214506 11/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7226 CHECK AMOUNT: $108.39
INDIANAPOLIS IN 46207 CHECK NUMBER: 214506
CHECK DATE: 11/1412012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 10/12-1 108 . 39 F & B TAX-10/12
X5 th.,e° FAB—1x 0 3 0 811
I declare nder penalti -eta ,t a e, 9" 7co`p ,/� (�
Date ���Z phone�,:6 l I L/ i Total Sales of Food&Beverages(Do Not Include Tax)......... A. U I (}
BROOKSHIRE GOLF CLUB Total Exempt Food&Beverage Sales................................... B. (�
Net Taxable Sales(Subtract Line B from Line A)................... C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(I%of Line .................................................. D.
OCT 2012 Collection Allowance(.73%of Line D) I
0003120155 009 0 Due on or Before Do Not Use this Line if the Payment is Late............................ E.
NOV 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 if return is filed late..................................... G.
❑ Check if Amended Carmel *The 2012 Annual nterest Rate is ai
II I I I I Adjustments(An explanation must be attached)...................... H.
t t I I I Total Amount Due(Total Lines F and G plus or minus Fl) I. 1 O •3
INDIANA DEPARTMENT OF REVENUE
P•0• BOX 7229
INDIANAPOLIS,IN 46207-7229
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Autho nzed FAB-1 03 0811
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Signawre
I declare'nd penalties of perjury that this is a true correct and comp! re M.
l—� �
Date ;.) 7 Total Sales of Food&Beverages(Do Not Include Tax)......... A. V
� � hone {_/!
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(1%of Line C).................................................. D
OCT 2012 Collection Allowance(.73%of Line D) i Q
Do Not Use this Line if the Payment is Late............................ E.
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice( ) or bill(s))
�f-7 log.
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
n.
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
C) Z Q 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