226051 11/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $96.24
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207
CHECK NUMBER: 226051
CHECK DATE: 11/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF F & B 1 96 . 24 TAXES-GOLF 9/13
Al
XA.fl ,;«d ° °� � FAB-103 0812
I declare under penal ies of perjury that this is a true,correect and
Date 1/ 13Phone t7 J 7( _ F Total Sales of Food&Beverages(Do Not Include Tax)_ A.
Total Exempt Food&Beverage Sales B. 111
BROOKSHIRE GOLF CLUB
Net Taxable Sales(Subtract Line B from Line A) C. `(
CARMEL UTILITIES
Taxpayer ID Number For Tax Period Tax Due(1%of Line C) D. G�
OCT 2013 Collection Allowance(.73%of Line D)
0003120155 004 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)*
County/Town Use this line only if return is filed late G (�J
❑Check if Amended Hamilton-29000 *The 2o13 Annual Interest Rate is3%
Adjustments(An explanation must be attached) H
Itil�lilili�illinllnlltn��ll��ll�l Total Amount Due(Total Lines F and G plus ortninusH) I.
INDIANA DEPARTMENT OF REVENUE J
P•0• BOX 7229
INDIANAPOLIS, IN 46207-7229
0800001 1355495001025290001,5971,031,20130.4
Xs,_,a,<<rd FAB-103 0812
I declare w er penal tes o perjury t at u erttc, or and com to ret
t
Phone� 'I % 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. t%
Taxpayer ID Number . For Tax Period Tax Due(1%of Line C) D.
OCT 2013 Collection Allowance(.73%ofLine D)
0003120155 004 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 S5 or 10%of Line F(Plus Interest)* �)
County/Town Use this line only if return is filed late G
❑Check if Amended Carmel-29291 *TIte 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H f
Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE 111
P•0. BOX 7229
INDIANAPOLIS, IN 46207-7229
Itlt 111111„1I1III111I111111111111111111111111111111 1111111111 080000113554951010252929115971031201304
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm 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
Pf Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
bo47 YO 7'
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.
and�� �/1 �/ ALLOWED 20
f I (/�--
IN SUM OF $
o
$
ON ACCOUNT OF APPROPRIATION FOR
n�! �
r d
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