HomeMy WebLinkAbout228864 2/5/2014 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $0.71
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 228864
CHECK DATE: 2/5/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 T & B 2 . 71 F & B-GOLF JAN 2014
FAB-103 0812
XAuthorized
S'mature
1 declare u der penalt's of perjury that this is a r�u/e,correct and comple M.
t2 ,
Date= Phone cel��(' 7 F Total Sales of Food&Beverages(Do Not Include Tax) A. 7 61
Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR
CARMEL UTILITIES
Net Taxable Sales(Subtract Line B from Line A) C. 7 Taxpayer ID Number For Tax Period Tax Due(I%ofLine Q D. ,7c�
JAN 2014 Collection Allowance(.73%of Line D)
0003120155 004 0 Due on or Before Do Not Use this Line if the Payment is Late E
MAR 03 2014 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 ifreturn is filed late G.
❑Check if Amended Hamilton-29000 *The 2014Annual Interest Rate is3%
Adjustments(An explanation must be attached) II.
liiltltltltllttttll�r�tltlittlltlt�ll Total Amount Due(Total Lines Fand Gplus orminus H)_ I. 7
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
Itlt�l�ll�tttitlllt��lt��ll���lttl�l��l�ll�l����ltlltl��ll���l 080000113554950010252900015970131201406
VA
XSthried (,, 4 FAB-103 0812
I decl u er atties of perjury that is is a true,correct and com lete
/pay, `✓ d6.
Dat —_1!�1/ /� phone�7 �J Z7� ` Total Sales of Food&Beverages(Do Not Include Tax) A. /
1 Total Exempt Food&Beverage Sales B.
CITY OF CARMEL BROOKSHIRE GOLF COUR -7X-3q
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.
JAN 2014 Collection Allowance(.73%of Line D) /
Do Not Use this Line if the Payment is Late E.
0003120155 004 0 Due on or Before ^ + ,
MAR 03 2014 Net Tax Due(Subtract Line E from Line D) F. ! I
Penalty is Greater of$5 or 10%of Lure F(Plus Interest)*
County/Town Use this line only ifretum is filed late G.
❑Check if Amended Carmel-29291 The 2014 Annual Interest Rate is 3%
Adjustments(An explanation must be attached) g
li�ltltltlilllloll litt1ltl1ttlltlttll Total Amount Due(Total Lines F and G plus or minus H)
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS, IN 46207-7229
Itll�ltll��ttl�lll�ttl�t�llt��l��l�lttl�ll�l����l�ll�l��ll���l 080000113554951010252929115970131201406
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.
W" D��
Payee
W 10aPurchase 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 accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
p 1 ALLOWED 20
IN SUM OF $
C-7 I
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
o 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
Signature
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund