221790 07/10/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
1 � ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $187.11
;'®r CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 221790
CHECK DATE: 7/10/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B 6/13 2 187 . 11 F & B TAX 6/2013
AwhorimJ A/ F A B—1 B 3 0 812
1 declare u tder pen pequ -t{+taWt r o and J'om a ret (�
Date e l 3 Phone� - Total Sales of Food S Beverages(Do Not Include Tax) A.
(-Z` Total Exempt Food&Beverage Sales 13.
BROOKSHIRE GOLF CL B
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. I r
JUN 2013 Collection Allowance(.73%of Line D) i •� (•,
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late E. 1�
JUL 30 2013 Net Tax Due(Subtract Line E from Line D) F. f
Penalty is Greater of S5 or 10%of tine F(Plus Interest)*
County/Town Use this line only dretum is filed late G.
Check if Amended Carmel-29291 'The 2013 Annual Interest Rate is 3".b
Adjustments(An explanation must be attached) H.
Il�lil�l�ltlll�lllillitllltlilllill�l Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P•0. BOX .7229
INDIANAPOLIS, IN 46207-7229
Ill��itlllll�lllllllll�tlllll�l,Il�l�ll�llll�l��l�ll�l�tll�l�l 08000011355495101,0252929115970630201308
Xs,g�'„�.�° .,c .��` - ` ' F A B—1 B 3 0 812
1 declare u tder penalties of-perjury that this is a Lme,correct a,n//d comp) e re nn. if
Date ��(� Phone I J7( l�U' 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.
�y �( /� l
Taxpayer ID Number For Tax Period Tax Due(]%of Line C) U. I 0 !> 'T G
JUN 2013 Collection Allowance(.73%of Line D)
0003120155 009 0 Due on or Before
Do Not Use this Line if the Payment is Late E.
JUL 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 G.
Check if Amended Hamilzon-29000
'The 2013 Animal Interest Rate is 3%
Adjustments(An explanation must be attached) H. )
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
Ill�llrll�r�ll�lll�„It��ll���l��l�l�ll�llll�l��l�ll�ll�llllll 080000113554950010252900015970630201308
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 �)
i
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
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
iCYature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund