HomeMy WebLinkAboutENGLEDOW, INC. - $109.62 - 4/13/2012 Statement of Account
Date: 4/13/2012
Account: 3153
Engledow, Inc. 'Page: 1
1100 East 116th Street
Carmel IN 46032
CARMEL REDEVELOPMENT COMMISSION
30 W. MAIN STREET
SUITE 220
CARMEL IN 46032
Site Location:
Carmel Redevelopment Commission
Document,No.• Date Code Description Invoice ,Payment Balance
355929 2/21/2012 SLS 1,675.62 1,675.62
PYMNT000000046173 3/23/2012 PMT Applied: 355929 1,566.00 109.62
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Amount Due: 109.62
For questions about your account, contact Michelle
at MSwinford @engledow.com or(317)819-3225.
Please bring your account current. Thank-you!
Current 31 -60 Days 61 -90 Days 91 -120 Days 121 and over
0.00 109.62 0.00 0.00 0.00
Form ST-105 Indiana Department of Revenue
State Form 49065 R4/8-05 General Sales Tax Exemption Certificate
Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana
code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certificate can not be issued for the
purchase of Utilities, Vehicles, Watercraft, or Aircraft. Purchaser must be registered with the Department of Revenue or the appropriate taxing
authority of the purchaser's state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide all required
information must pay the tax and may file a claim for refund(Form GA-110L)directly with the Department of Revenue.
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Name of Purchaser City of Carmel (Carmel Redevelopment Commission, an enterprise fund)
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Business Address 30 West Main Street, Suite 220 City Carmel State IN Zip 46032
six Purchaser must provide minimum of one ID number below.*
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Provide your Indiana Registered Retail Merchant's Certificate 0031201550 — 020
re: TID and LOC Number as shown on your Certificate
u+ .11D#(10 digits) LOC#(3 digits)
`0'` If not registered with the Indiana DOR,provide your State Tax
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ID Number from another State
Ilia *See instructions on the reverse side if you do not have either number. State ID# State of Issue
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r>~; Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one)
36v Description of items to be purchased.
Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain)
3 ❑ Sales to a retailer,wholesaler,or manufacturer for resale only
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0 Sale of manufacturing machinery,tools,and equipment to be used directly in direct production.
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0 Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10.
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(May not be used for personal hotel rooms and meals.)
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❑ Sales of tangible personal property predominately used(greater then 50 percent)in providing public transportation-provide USDOT#.
Sf?; A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a school bus operator,must
o provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT#
❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale.
Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a State ID#in Section#1.
zgy O Sales to a contractor for exempt projects(such as public schools,government,or nonprofits).
?: t ® Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and state universities).
,,<•0 Sales to the United States Federal Government-show agency name.
Note:A U.S.Government agency should enter its Federal Identification Number(FTL)#)in Section#1 in lieu of a State ID#.
❑ Other-explain.
I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt
purpose pursuant to the State Gross Retail Sales Tax Act,Indiana Code 6-2.5,and the item purchased is not a utility,vehicle,watercraft,or aircraft.
gq-.I confirm my understanding that misuse,(either negligent or intentional),and/or fraudulent use of this certificate may subject both me personally
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;Z5 and/or the business entity I •. -sent to t e i •.sition of tax,interest,and civil and/or criminal penalties.
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Signature of Purchaser r
2-/2//f� Date (2.
"'^a Printed Name Les Olds Title Redevelopmet Dir
The Indiana Department of Revenue may request verification of registration in another state if you are an out-of-state purchaser.
Seller must keep this certificate on file to support exempt sales.