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Home My WebLink About234822 07/16/14 ;`r`�.s+_A,�F. CITY OF CARMEL, INDIANA VENDOR: 368205 ONE CIVIC SQUARE CYNTHIA LAYNE CHECK AMOUNT: $*******600.00* =Q CARMEL, INDIANA 46032 8117 CARLOW CIRCLE CHECK NUMBER: 234822 9.y,�TON:�. INDIANAPOLIS IN 46214 CHECK DATE: 07/16/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1203 4359003 31755 080214 600.00 JAZZ ON THE MONON i4 Date: July 8, 2014 '& ' Invoice # 080214 I{ Cynthia Harden Bill to: d/b/a Cynthia Layne City of Carmel 8117 Carlow Circle Community Relations Indianapolis, IN 46214 One Civic Square Carmel, IN 46032 ,d P.O. #31755 p I r DESCRIPTION ; TOTAL Performance at Jazz on the Monon 8/2/14 $600.00 O>t� ID po-q 4359063 Total Due $600.00 Please make all checks payable to: Cynthia Harden THANK YOU FOR YOUR BUSINESS! 1 1 I I Fon:, W-9 Request for Taxpayer Give Form to the (Rev.August 2013) Identification Number and Certification requester.Do not Department of theTreasury send to the IRS. Internal Revenue Service Ns shown on your income tax return) (a ) N -Tusine4 name/disregarded entity name,if different from above i } t `� ChecapPrapr ate box for federal tax classification: Exemptions(see instructions): o IndividuaUsole proprietor ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate ul CL o Exempt payee code(d any) c*150 LSmited liability company-Enter the tax classification(C=G corporation,SS corporation,P=partnership)► Exemption from FATCA reporting rn code(rf any) IL ❑ Other(see instructions)► Address(number, t,and apt.or suite n) Requesters name and address(optional) L� City,state,and ZIP e 1O W Li I Oa ILIUst account numtW(s) ere(optionao 900111 Taxpayer Identification Number MN) Ester your TIN in the appropriate box.The-nN provided must match the name given on the"Name"line Social security number to avoid backup withholding.For individuals,this Is your social security number(SSM.However,for a entities,it is your employer identification number(EIN).If you do not have a number,see How to get a T!N on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number ' number to anter. M M Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be Issued to me),and 2. 1 am not subject to backup withholding because,(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3, t am a U.S.citizen or other U.S.person(defined below),and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA repotting Is correct. Oertitication Instructions.You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or donment of secured p perty,cancellation of debit,contributions to an individual retirement arrangement PRA),and generally,payments othe a. interest and dividens, ou are not required to sign the certification,but you must provide your correct TIN.See the Instructions on page 3. f Sign Signature Here U.S.person (�, Data I. General Instruction withholding tax on foreign partners'share of effectively connected income,and 4-Certify that FATCA code(s)entered on this form(if any)indicating ttrat you are Section references are to the int Revenue Code unless otherwise noted, exempt from the FATCA reporting,is correct, Future deveiopmants.The IRSbas created a page on iRS.gav for information Note.if you are a U.S.person and a requester gives you a form other than Form about Form W-9,at www.ftgov/w9.Information about any future developments W-9 to request your TIN,you must use the requests form if it is substantially affecting Form W-9(such as legislation enacted after we release it)will be posted similar to this Form W-9. on that page. Definition of a U.S.person.For federal tax Purposes,you are considered a U.S. Purpose of Form person if you are: A person who is required to file an Information return with the IRS must obtain your 'An individual who is a U.S.citizen or U.S.resident alien, correct taxpayer identification number(nN)to report,for example,income paid to •A partnership,corporation,company,or association created or organized in the you,payments made to you in settlement of payment card and third party network United States or under the laws of the United States, transactions,real estate transactions,mortgage interest you paid,acquisition or .An estate(other than a foreign estate),or abandonment of secured property,cancellation of debt,or contributions you made to an IRA, •A domestic trust(as defined in Regulations section 301.7701.: . Use Fonn W-9 only if you are a U.S.person(including a resident alien),to Special rules for partnerships.Partnerships that conduct a trade or business in provide your correct TIN to the person requesting it(the requester)and,when the United States are generally required to pay a withholding tax under section applicable,to: 1446 on any foreign partners'share of effectively connected taxable income from such business.Further,in certain cases where a Form W-9 has not been received, i.Car*that the TIN you are giving Is correct(or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is a to be issued), foreign person,and pay the section 1446 withhoklbng tak lberefors,if you are a 2.Certify that you are not subject to backup withholding,or U.S.person that is a partner in a partnership conducting a trade or business in the S.Claim exemption from backup withholding if you are a U.S,exempt payee.if United States,provide Form W-9 to the partnership to establish your U.S.status applicable,you are also certifying that as a U.S.person,your allocable share of and avoid section 1446 withholding on your share of partnership income. ,any partnership income from a U.S.trade or business is not subject to the Cat.No.10231X Form W-g(Rev.8-2013) VOUCHER NO. WARRANT NO. ALLOWED 20 Cynthia Harden d/b/a Cynthia Layne IN SUM OF$ 8117 Carlow Circle Indianapolis, IN 46214 $600.00 ON ACCOUNT OF APPROPRIATION FOR Community Relations PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 31755 080214 43-590.03 $600.00 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 Thursday,July 10,2014 Director, Community Relations/Economic Development Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER 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)) 07/08/14 080214 $600.00 I 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