220874 06/13/2013 ,f 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: $183.38
INDIANAPOLIS IN 46207 CHECK NUMBER: 220874
CHECK DATE: 6/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B TAX 1 183 . 38 F & B TAX 6/13 1
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Xs�;,0,i.d ' �,� �, a.., ' °� F A B—103 0 812
I declare nder penalties of perjury that this is a tt uuee,,'cJorrect and coin e. li M. !
Dacca' I Phone •J 1 I ZL�' Total Sales of Food&Beverages(Do Not Include Tax) A. I L1 � � a
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB Q
Net Taxable Sales(Subtract Line B from Lute A) C.
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D. t `�
MAY 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
JUL 01 2013 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 retum is filed late G.
❑Check if Amended Carmel-29291 `The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) g
Itt Iti tl�li�itlllitl�rtl�lritllttllil Total Amount Due(Total Lines F and 0 plus or minus H)_ L l 3• � �
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
1111�11II....I�III���I���ll�t�I��I tl�tltlltl�tt�ltll�l��ll�ttl 0800001,13554957,01,02529291,1,5970531,201310
XAaih„ri-d (�VJ9Fr[l ,l� ,, F A B—1,0 3 0 812
sloaOnne N tl 1 Y T f
I declare�undgv el alftes'cttp''�rjtlohuA ' a tr� orre_c an comp) 'eturn. ` ..�
.I _ ]cone I� G I � -- F Total Sales of Food&Beverages(Do Not Include Tax) A. (J '�) 1l
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB
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.
MAY 2013 Collection Allowance(.73%of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E.
JUL 01 2013 Net Tax Due(Subtract Line E from Line D) F. I i� J
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-29000 *The 2013 Annuat Interest Rate is 3%
1 1 1 1 III I 1 1 11 I I I Adjustments(An explanation must be attached) H.
tt t i 1 tttt ii n� ttt n t I �� •c/
Total Amount Due(Total Lines F and G plus or mucus M I.
INDIANA DEPARTMENT OF REVENUE
P-0• BOX 7229
INDIANAPOLIS, IN 46207-7229
ItI��I�II���tI.III...11��II��t I��I tl��l�ll�l��rtl�lltl��ll�ltl 08000011355 495001025290001597053120131,0
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
3�?U� &�x �—L Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0312
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
i
Board Members
Po#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
Z D l 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
Si A19
na ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund