226892 12/10/2013 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
\yf ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
.o CARMEL, INDIANA 46032 PO Box 7226 CHECK AMOUNT: $49.22
INDIANAPOLIS IN 46207 CHECK NUMBER: 226892
CHECK DATE: 12/1012013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 GOLF F & B 1 49 . 22 GOLF F & B-NOV 2013 1
Xs`a°rizd Am�-, s �A°B 0 3 0 812
I dec"gn
s of er u t hat t 's• e�Otre t n p i lete�um.
F$;0P
Pho ' ti ".` (ital Sales of Food&Beverages(Do Not Include Tax) A.7 -7 '-//J Exempt Food&Beverage Sales B.
BROOKSHIRE GOLF CLUB r 7 (
�1
Net Taxable Sales(Subtract Line B from Line A) C. ,�d 12
CARMEL UTILITIES a
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D. 7 7
NOV 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 30 2013 Net Tax Due(Subtract Line E from Line D) F.
Penalty is Greater of S5 or 10%of Line F(Plus Interest)* G !i
County/Town Use this line only if return is filed late
❑Check if Amended Hamilton-29000 *The 2013 Annual l nterest Rate is 3%
Adjustments(An explanation must be attached) g
I I I I I I I I I n I I n I I I n I n I n I l I n 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
I.II�IIII���IIIIII�I�I��IIII�IIIII�IIIIIII�I����I�II�I�III�I�I 080000113554950010252900015971130201302
Xsethotrize' FAB-103 0812
1 declare under penalties of perjury that this is7a true,correct and Jer�u Date j��Phone 3 ( ��— Total Sales of Food&Beverages(Do Not Include Tax) A.
1��� Total Exempt Food&Beverage Sales B. I-
BROOKSHIRE GOLF CLUB
CARMEL UTILITIES p
Net Taxable Sales(Subtract Line B'from Line A) C. `�U D
�j
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D.
NOV 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. 3 }�
DEC 30 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 retum is filed late G.
❑Check if Amended Carmel-29291 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) A
Inl�ltltllttlltillitllttlttlllttlltl Total Amount Due(Total Lines F and G plus or minus H)_ I. 2 2
INDIANA DEPARTMENT OF REVENUE
P•0. BOX 7229
INDIANAPOLIS, IN 46207-7229
I.I..Itlll...I.III...II,.II...II�Ill�lllll�ll��ll�ll�l��lltl�l 080000113554951010252929115971130201302
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
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
IV, ) V V � IN SUM OF
—P,
k4j)s 1N 4tml
$ ,� IItZZ
ON ACCOUNT OF APPROPRIATION FOR
ben T�Llnqi- U kv
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
I Z�, 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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund