215937 01/08/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
eyp(ep� CARMEL, INDIANA 46032 SYSTEM SERVICES CHECK AMOUNT: $8.38
PO BOX 6197 CHECK NUMBER: 215937
INDIANAPOLIS IN 46206-6197
CHECK DATE: 1/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF-12/12 1 8 . 38 GOLF-12/12 F & B
X S%..iz yq
FAB-103 0811 UAW A, —
StsnaNre I i W.
I declare under penalties of perjury that-this 7is a true,corX-44,mplet M. L� 2L
Date I ` Phone ( Total Sales of Food&Beverages(Do Not Include Tax)......... A.
BROOKSHIRE GOLF CLUB
Total Exempt Food&Beverage Sales................................... B.
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A)................... C.
Taxpayer ID Number For Tax Period Tax Due(1%of Line C).................................................. D.
DEC 2012 Collection Allowance(.73%of Line D) r t
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late............................ E.
G
JAN 30 2013 Net Tax Due(Subtract Line E from Line D)............................ F. O
Penalty is Greater of$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only if return is filed late..................................... G.
❑Check if Amended Hamilton *The 2012 Annual Interest Rate is 4%
Adjustments(An explanation must be attached)...................... H.
I��I�I�lililli�i�tllrll��tt�illitll�l
Total Amount Due(Total Lines F and G plus orminus ) I.
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
INDIANAPOLIS,IN 46207-7229
080000113554950010252900015971231201200
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CITY OF CARMEL
Brookshire Golf Course
Calculation of Sales and Food & Beverage Taxes Owed
December 31, 2012
Total Non-Taxable Taxable
Sales Sales Sales
Green Fees 7,048.57 7,048.57 0.00
Membership Fees 8,150.00 8,150.00 0.00
Cart Fees 2,204.24 2,204.24
Member Cart Fees 645.76 645.76
Gift Cards Sold 1,015.00 1,015.00 0.00
Pro Shop Non Taxable 0.00 0.00 0.00
Pro Shop Taxable 1,248.53 1,248.53
Food and Beverage Non Taxable 0.00 0.00 0.00
Food and Beverage Taxable 844.26 844.26
Total 21,156.36 16,213.57 4,942.79
Total Non-Taxable Taxable Tax
Sales Sales Sales Payable
Sales Tax 21,156.36 16,213.57 4,942.79 346.00
Interest 0.00
Penalty 0.00
Collection Allowance (2.53)
343.47
Carmel Hamilton
Total Non-Taxable Taxable FAB Tax FAB Tax
Sales Sales Sales Payable Payable
FAB Tax 844.26 0.00 844.26 8.44 8.44
Interest 0.00 0.00
Penalty 0.00 0.00
Collection Allowance (0.06) (0.06)
8.38 8.38
Total Period Sales.Taxe&.0wed 343,47
Total:Period FAB Taxes Owed �16 76
Taxes collected. 347060; 966'1,
347070 93
347080
iA
:� =5:93
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
I1 (
r 1� C L Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
F�! . Z Z , 3K
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
(L 2L
V IN SUM OF $
$ g , 38
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