HomeMy WebLinkAbout215541 12/18/2012 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: $22.86
INDIANAPOLIS IN 46207
CHECK NUMBER: 215541
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 22 . 86 GOLF-F & B TAX 11/12
XSgnat- - FAB-103 0811
I declare under penalties of perjury that this is a true,ccoo rest and compt re m.
Date Phone �1 J !I z Total Sales of Food&Beverages(Do Not Include Tax)......... A.
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 .................................................. D.
NOV 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.
DEC 31 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 l ate..................................... G,.
❑ Check if Amended Carmel *The 2012 Annual Interest Rate is 4%
Adjustments(An explanation must be attached)...................... H.
Ittltlililtitllttlltttlltttttlltllill Total Amount Due(Total Lines F and G plus or minus ll) I. a: C
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS,IN 46207-7229
I�I�II�III���IIIIIe��I��IIL�IL�I�L�I�ILIIt��IIILL�II���I 080000113554951010252929115971 130201201,
W
X Authorized - FAB-103 0811 444.4 Signature
I declare under penalties of perjury that this is a true,correct and complete re )
Date `I) �) Phone 7 Total Sales of Food&Beverages(Do Not Include Tax)......... A. T 0 J�
BROOKSHIRE GOLF CLUB
Total Exempt Food&Beverage Sales................................... B.
/- .a (,
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A)................... C. v JA /� D
Taxpayer ID Number For Tax Period Tax Due(I%ofLine C).................................................. D. C'
NOV 2012 Collection Allowance(.73%ofLine D)
0003120155 009 0 Due on or Before Do Not Use this Line if the Payment is Late............................ F
DEC 31 2012 Net Tax Due(Subtract Line E from Line D)............................ F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)* 4 (�
County/Town Use this line only if return is filed late..................................... G.
❑Check if Amended Hamilton *The 2012 Annuat Interest Rate is 4%
Adjustments(An explanation must be attached)...................... H.
l l u l l l l u u�l i n l�l l Total Amount Due(Total Lines F and G plus or minus H) I. ,( $47
INDIANA DEPARTMENT OF REVENUE `
P-O- BOX 7229
INDIANAPOLIS,IN 46207-7229
It1�ILI1����lIIII���L��IIr��L�I�L�LIi�L���l�ll�l��ll���l 080000113554950010252900015971130201201
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(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
wC IN SUM OF $
$ �o
ON ACCOUNT OF APPROPRIATION FOR
6M Awe
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
�J - G 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