HomeMy WebLinkAbout227634 1/8/2014 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
yf. ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CARMEL, INDIANA 46032 PO BOX 7229
CHECK AMOUNT: $11.43
INDIANAPOLIS IN 46207 CHECK NUMBER: 227634
CHECK DATE: 1/8/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B TAX 1 11 .43 GOLF-F & B 12/13
A
XAulh tr''ed .� FAB—103 0 812
a
1 declare u tder enaIties of perjury that this is a true,correct and ompI urn.
h
Date phone �j / J I Total Sales of Food&Beverages(Do Not Include Tax) A. f U V
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(I%of Line C) D.
DEC 2013 Collection Allowance(.73%ofLine D)
Do Not Use this Line if the Payment is Late Fi
0003120155 004 0 Due on or Before
JAN 30 2014 Net Tax Due(Subtract Line E from Line D) F. 1
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 Hamilton-29000 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H
I�tltltltl�lltitttlltlltt�titlltlttll Total Amount Due(Total Lines Fand Gplus orminus H)_ 1.
INDIANA DEPARTMENT OF REVENUE f
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
I�I��I�Ilttttl�lll���l�t�llt��l�tl�l�tl�litlttt�l�ll�lttll��tl 0800001,1,355495001,0252900015971231201301
X
FAB-103 0812
Auninized -
Signamre
I declare under p/en`a'ltics of perjury that this is a true,correct and co)tiplete r t.
Date ( Phone L` Total Sales ofFood&Beverages(Do Not Include Tax) A.
BROOKSHIRE GOLF CLUB
Total Exempt Food&Beverage Sales B.
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. ( 1
DEC 2013 Collection Allowance(.73%of Line D)
0003120/55 004 0 Due on or Before Do Not Use this Line if the Payment is Late E. (98
JAN 30 2014 Net Tax Due(Subtract Line E from Line D) F. I 49
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) H
I�tltltltltllttt�tll�lltittttlltlttll Total Amount Due(Total Lines Fand Gplus orminusH)_ I. f 3
INDIANA DEPARTMENT OF REVENUE t
P-0. BOX 7229
INDIANAPOLIS, IN 46207-7229
I�It�ltll����l�llltttl�ttll�ttl�tltlttl�ll�l�„�Itll�l��llt��l 080000113554951010252929115971231201301
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Fonn 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� / '�Iw Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
171
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
p ALLOWED 20
IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
w, - IJ42—4
r
Board Members
PO#or DEPT.# INVOICE NO. ACCT#/TITLE AMOUNT , I hereby certify that the attached invoice(s),
w 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
44 20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund