HomeMy WebLinkAbout220875 06/13/2013 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: $183.38
.? INDIANAPOLIS IN 46207
„o„ o CHECK NUMBER: 220875
CHECK DATE: 6/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B TAX 2 183 . 38 F & B TAX 2
XAunhonzed
z ��1 �� � � FAB-103 0812
'E yk +�
1 declare under penalties of perjury that this is a'trruue,correct and com2We7eturn. !� _
Datd✓ I I Phone �11 'J�I Z F Total Sales of Food&Beverages(Do Not Include Tax) A.
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB
CARMEL UTILITIES Net Taxable Sates(Subtract Line B from Line A) C.
Taxpayer ID Number For Tax Period Tax Due(I of Line C) D. l
MAY 2013 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late _ E.
0003120155 004 0 Due on or Before
JUL 01 2013 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of S5 or 10%of Line F(Plus Interest)*
County/Town Use this line only if return is filed late G
Check if Amended Carmel-29291 'The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
I I I l l l n l l l l l u l n l l l l l l l l l l l l l Total Amount Due(Total Lines F and G plus or minus H)_ I.
INDIANA DEPARTMENT OF REVENUE
P-0• BOX 7229
INDIANAPOLIS, IN 46207-7229
I.I..I�II����ltllil��I�I�IiII�I��IIIIIIIIIII���IIIIIII��II�I�I 0800001 1355495 101,02529291[15970531,201310
FAB-103 0812
XSuV-izcJ J
Signature / e
1 declare un et�e `{ � t--
p a$tes o ra t �rrec�'an com I eturn.Date C/ Phone '_) I � Total Sales of Food&Beverages(Do Not Include Tax) A.
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(I%of Line C) D.
MAY 2013 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late E. IF
0003120155 004 0 Due on or Before
JUL 01 2013 Net Tax Due(Subtract Line E from Line D) F. J
Penalty is Greater of$5 or 10°o of Line F(Plus Interest)*
County/Town Use this line only if return is filed late G.
❑Check if Amended Hamilton-29000 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H (,l
Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE c/
P.O. BOX 7229
INDIANAPOLIS, IN 46207-7229
I�I��I�II����I�III���I��III.�tlltl�lttltlltl����l�ll�l„Il�ttl 080000113554950010252900015970531201310
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.
I Payee I
Y `�•% ` " Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
r
!\
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
G IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
� - N
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
A,
gn"at ure
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund