226029 11/13/2013 ��A,f CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $96.24
`�,? CARMEL, INDIANA 46032 SYSTEM SERVICES
oN.o PO BOX 6197 CHECK NUMBER: 226029
INDIANAPOLIS IN 46206-6197
CHECK DATE: 11/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF F & B 2 96 . 24 GOLF-F & B 9/13
AudunizeJ
' a. FAB-103 0812
Signatore
1 declare under penal ies of perjury that this is a true,correct and con fete
Date 1/ j �3Phone 3�7 / I 2 F 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(1%of Line C) D.
OCT 2013 Collcction Allowance(.73%of Line D)
0003120155 009 0 Due on or Before Do Not Use this Line if the Payment is Late _ E.
DEC 02 2013 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)* 'Z'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
Iitl�lllilt��IIInIInIltn��Illlll�l Total Amount Due(Total Lines F and G plus ortninusH)_ 1.
INDIANA DEPARTMENT OF REVENUE w v
P•0• BOX 7229
INDIANAPOLIS, IN 46207-7229
IIIII IIIII 111 11 III 111I111II111I11111111111111111 II 111111111111 08000011355495001025290001597103120130.4 -
XsQao;"J FAB-103 0812
]declare wl ies o perjury t at Fs vru,.eor and comp f to ret �
Date`Al� '�_i✓Phone '��f/ Total Sales of Food&Beverages(Do Not Include Tax) A.
BROOKSHIRE GOLF CLUB
Total Exempt Food&Beverage Sales B.
a
CARMEL UTILITIES
Net Taxable Sales(Subtract Line B from Line A) C.
Taxpayer ID Number , For Tax Period Tax Due(1%of Line C) D.
OCT 2013 Collection Allowance(.73%ofLine D)
Do Not Use this Line if the Payment is Late E.
0003120155 004 0 Due on or Before '
DEC 02 2013 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of$5 or 10%of Line F(Plus Interest)* `) 7
County/Town Use this line only if remm is filed late G. i C—
❑Check if Amended Carmel-29291 `The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H
Ittl�Itltlt t�Ilittlllillliiitll��llil Total Amount Due(Total Lines P and G plus oninusH)_
INDIANA DEPARTMENT OF REVENUE n
P.0• BOX 7229
INDIANAPOLIS, IN 46207-7229
080000113554951010252929115971031201304
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))
l"
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
Ad66 I P-AF(MUC-0-
IN SUM OF $
To 7�uXi
I � �Ij 469,V7-
I� Zq
ON ACCOUNT OF APPROPRIATION FOR
(�- 6mc� �
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
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund