224755 10/07/2013 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: $148.93
"? INDIANAPOLIS IN 46207
CHECK NUMBER: 224755
CHECK DATE: 10/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2 148 . 93 F & B GOLF-9/13
XA.1h.,red i ' +s t9 fj FAB—10 3 0 812
I declare under en Iii e, rr7 an c n'pl a ret
Date to 1?) Phone (� -71-v `., F Total Sales of Food&Beverages(Do Not Include Tax) A. O a 5 a
BROOKSHIRE GOLF CLUB Total Exempt Food&Beverage Sales B.
CARMEL UTILITIES Net Taxable Sales(Subtract Line B from Line A) C. I 0 0 Z- 6
�.
Taxpayer ID Number For Tax Period Tax Due(I%of Line Q D. V 0
SEP 2013 Collection Allowance(.73%of Line D) I I
0003120155 004 0 Due on or Before O
Do Not Use this Line if the Payment is Late E.
OCT 30 2013 Net Tax Due(Subtract Line E from Line D)
Penalty is Greater of S5 or 10%of Line F(Plus Interest)*
County/Town Use this line only if return is filed late C
❑Check •i£ Amended Hamilton-29000 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) II
Initltltltttlltllnntlinttllttllll Total Amount Due(Total Lines F and G plus or minus H)__
INDIANA DEPARTMENT OF REVENUE l
P•0. BOX 7229
INDIANAPOLIS, IN 46207-7229
Ilittltlit�ttlt III„tlt.tllt.tlttitlttltlltlttltltlltlttlllttl 0800001135549500 10252900015970930201309
XS,o`a�rd �� • . ( �n FAB-103 0812
I declare and r penaltiex'aof pep tt mt t�s is ,c ec and co iplete retu ��
Date (��3`� Phone (� I � � Total Sales of Food&Beverages(Do Not Include Tax) A. I p�
Total Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B from Line A) C. , `�c 0 -2 7 Z
CARMEL UTILITIES q� 3
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D. v
SEP 2013 Collection Allowance(.73%ofLine D)
0003120155 004 0 Due on or Before
Do Not Use this Line if the Payment is Late E.
C.�- Q
OCT 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 C_
Check if 'Amended Carmel-29291 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H
li i I i l i l i l t,t l l t i l n t,t l l l l t t l l i t l l t l Total Amount Due(Total Lines F and G plus or tninus H)
. INDIANA DEPARTMENT OF REVENUE
P•0. BOX 7229
INDIANAPOLIS, IN 46207-7229
Itittltllttttlt IIItt.Itttiltttl.tltlttitlltlttttltlltlttlltttl 08000011355 4951010252929115970930201309
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
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
,0 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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund