HomeMy WebLinkAbout223757 09/05/2013 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: $186.20
INDIANAPOLIS IN 46207 CHECK NUMBER: 223757
CHECK DATE: 9/5/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF 8/13-1 186 . 20 GOLF F & B-8/13 1
X Authorized FAB-1.10 3 0 812
Si_nature
I declareunder p nalq s o erjup tai u t orr and complete re
Dare L/1 J 0 Phone 5/ r71 ( Total Sales of Food&Beverages(Do Not Include Tax) A. 75 6
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB 7
Net Taxable Sales(Subtract Line B from Line A) C. I !_V
CARMEL UTILITIES r ' 7
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D.
AUG 2013 Collection Allowance(.73%of Line D)
Do Not Use this Line if the Payment is Late E.
0003120135 004 0 Due on or Before / /J
SEP 30 2013 Net Tax Due(Subtract Line E from Line D) F. C j� �c
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 Carmel-29291 'The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
Ittltltlilinl tlltitlulllttlllnllll Total Amount Due(Total Lines F and G plus orminusH) 1. 6 G- r
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
1�1111111t�111�111��111��11�1�1tt1�1111111�111t�1�ll�ittll���l 0800001,1,3554951,01,02529291,15970831,201300
X Authorized
FAB-103 0812
Si�namrc - -
I declare a id r peRaliies of perjury that tt is is a true,correct and compl etum.
Date �x l Phone 31 �� —�' F Total Sales of Food&Beverages(Do Not Include Tax) A. ✓y % /T)
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B fi,om Line A) C.
CARMEL UTILITIES 7 S 7
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D.
AUG 2013 Collection Allowance(.73%of Line D) ``��, 7
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late E. 1
SEP 30 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 return is filed late G.
Check if Amended Hamilton-29000 'The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) g
l u l t l l l i l t n l 111 t t t l t t l l t t t e l l i t l l l l Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P-O- BOX .7229
INDIANAPOLIS, IN 46207-7229
1111t1111�1t�l�lll��tl�t�ll���l�11t11t111111����l�ll�1�1111�t1 080000113554950010252900015970831201300
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
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
1 -D(4Z IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
&41 ZA- 00
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.
16 1 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
gnature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund