219627 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229 CHECK AMOUNT: $64.38
? INDIANAPOLIS IN 46207
o„ CHECK NUMBER: 219627
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B GOLF 2 64 . 38 F & B GOLF 4/13
X Au[honzed
FAB-103 0812
Si�naiure ) /
I declare wt of pe tallies of perjn y that this is a true,correct and comple urn. /t
are /�- t/-'� 'L` Total Sales of Pood&Beverages(Do Not Include Tax) A. �6
Date�1J e( Phone �'I� ✓
Total Exempt Food&Beverage Sales M
BROOKSHIRE GOLF CLUB Net Taxable Sales(Subtract Line B from Line A)_ C. �' 4
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D•
APR 2013 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late E.
0003120155 004 0 Due on or Before
MAY 30 2013 Net Tax Due(Subtract Line 13 from Line D) F.
Penalty is Greater of S5 or 10%of Line F(Plus Interest)* I�
`�
County/Town Use this line only if return is filed late G. f
E]Check if Amended Hamilton-29000 'The 2013 Annual Interest Rate is 31,/6
y Adjustments(An explanation must be attached) H.
InI,I1lti,n,1111,1t11un1,11n11t1 Total Amount Due(Total Lines F and G plus or minus H)_ ]. /4
INDIANA DEPARTMENT OF REVENUE
P.O. BOX 7229
I
INDIANAPOLIS,
N'146207-7229
11111,1111111,1„1111,1„111111 080000113554950010252900015970430201300
X Authari,d
AB-103 0812
Senature /�
1 declare u d rr_penalties of perjury that this is a true,correct and complete to ( // X /
Date --'L(!� � Phone 3/7�7/ Zt'`• Total Sales of Food&Beverages(Do Not Include Tax) A. (�j'�! U (�
Total Exempt Food d Beverage Sales B. Q
BROOKSHIRE GOLF CLUB Net Taxable Sales(Subtract Line B from Line A) C. 6, 4S4 C,
CARMEL UTILITIES 64 .S5
Taxpayer ID Number For Tax Period Tax Due(1%of Line Q. D.
APR 2013 Coliection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late_ E• 1
0003120155 004 0 Due on or Before
MAY 30 2013 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
❑Check if Amended Carmel-29291 `The 2013 Annual interest Rate is 3%
Adjustments(An explanation must be attached) H.
In1,1tl1itntlllltltll,nntilnllll Total Amount Due(Total Lines F and G plus or minus 1-I)_
INDIANA DEPARTMENT- OF REVENUE
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
1,1„1,11,,,,11111,,,1„111,11111111111111111„111111111111111 080000113554951010252929115970430201300
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm 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 / n
Purchase Order No.
Terms
Date.Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)
6kx 771761E qh __3 bUK
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
-73A
, �&j c`7-jaDq
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
d ' 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