219154 04/18/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
`F ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CHECK AMOUNT: $6.42
PO BOX 7229
CARMEL, INDIANA 46032
INDIANAPOLIS IN 46207 CHECK NUMBER: 219154
OM
CHECK DATE: 4118/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF F & B 1 6 . 42 GOLF F & B 3/13
FAB-103 0812
F
Total Sales of Food&Beverages(Do Not Include Tax) A. ( 1 ( �`7
1 Total Exempt Food&Beverage Sales B.
Net Taxable Sales(Subtract Line B from Line A)_ C. 37
Tax Tax Due(1%of Line C) D. u q-7
Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late E. j1
Net Tax Due(Subtract Line E from Line D) F. v
Penalty is Greater of S5 or 10%of Line F(Plus Interest)*
Use this line only if return is filed late G. !� r
*The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) A.
Total Amount Due(Total Lines F and G plus or minus H)
..I 08000011,355 495101,0252929115970331,201,302
r,,�FAB-103 0812
FTotal Sales of Food&Beverages(Do Not Include Tax) A. �I 1
JJJJ����' Total Exempt Food&Beverage Sales B.
Net Taxable Sales(Subtract Line B from Line A) C. Gj
Tax Due(I%of Line C) D.
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 S5 or 10%of Line F(Plus Interest)*
Use this line only if return is filed late G. �i 7
*The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached)- H
Total Amount Due(Total Lines F and G plus or minus H) 1. I
I���I 080000113554950010252900015970331201302
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
W Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
en
3
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.
D, 0 NM In I j ALLOWED 20
IN SUM OF $
$
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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund