HomeMy WebLinkAbout227635 1/8/2014 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA DEPT OF REVENUE
CHECK AMOUNT: $11.43
CARMEL, INDIANA 46032 PO BOX 7226
,.i,�•>° INDIANAPOLIS IN 46207
CHECK NUMBER: 227635
CHECK DATE: 1/8/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 F & B TAX 2 11 .43 GOLF-F & B TAX 12/13
41 A
XAaulu-i,ea �, ❑ � + FAB—],03 0812
SignatI declare u tit enaIties of perjury that this is a true,correct and nip] um.
( ,ems,,''') r-']
Date 1 Phone =/ / J / l Total Sales of Food&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. ( 5 '0 �OJ�
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D.
DEC 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
,j
JAN 30 2014 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 tiled late G.
❑Check if Amended Hamilton-29000 *The 2013 Annual Interest Rate is 3%
II t I t Il l l l ill 11111 Adjustments(An explanation must be attached)
INDIANA DEPARTMENT OF REVENUE Total Amount Due(Total Lines F and G plus or minus H)—
I 3
P-0• BOX 7229
INDIANAPOLIS, IN 46207-7229
I.I.tllllttttllllltttltlllltttltlltlttltllllttttltlltlttlltttl 0800001 1355495001025290001,5971231,201301
FAB-1,03 0812
XAuthr z, B
Signature _
I declare u�nd�er p�enallties ofperjury that this is a true,correct and completer t.
Date l/ /I t Phone Total Sales ofFood&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. I V
Taxpayer ID Number For Tax Period Tax Due(I%of Line C) D. ( I
DEC 2013 Collection Allowance(.73n/of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E. (JX
JAN 30 2014 Net Tax Due(Subtract Line E from Line D)_ F. It . 4
Penalty is Greater o£$5 or 10%of Line F(Plus Interest)*
County/Town Use this line only if return is filed late G.
❑Check if Amended Carmel-29291 *The 2013 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) H.
IuItItltltlltttnlltllt,nulltlttll Total Amount Due(Total Lines Fand Gplus orminus H)_ I. j I _ lL
INDIANA DEPARTMENT OF REVENUE r 111
P•0. BOX 7229
INDIANAPOLIS, IN 46207-7229
Itittlllittttltllltttltttllttllttltlllltlltltttlltlltlttlltltl 080000113554951010252929115971231201301
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth 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.
I
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6 1
0 ,
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.
ALLOWED 20
IN SUM OF $
-T- o &� �))q
I rW�, ltS
$ 110
ON ACCOUNT OF APPROPRIATION FOR
Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.
# I hereby certify that the attached invoice(s),
IVj� 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