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Home My WebLink About242013 2 /10/2015 CITY OF CARMEL, INDIANA VENDOR: 00350077 ONE CIVIC SQUARE INDIANA STREET COMMISSIONERS AS,§bIECK AMOUNT: $*.....**35.00* CARMEL, INDIANA 46032 JOHN SCHNADENBERG-MEM DIR CHECK NUMBER: 242013 vy. 1490 BROADWAY SUITE 1 CHECK DATE: 02/10/15 CHESTERTON IN 46304 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4355300 35.00 ORGANIZATION & MEMBER INDIANA. STREET_ COMMISSIONER'S ASSOCIATION www.indianastreets.org 2015 I.S.C.A. MEMBERSHIPS ARE NOW DUE MAKE CHECKS PAYABLE TO: I.S.C.A. (Indiana Street Commissioners Assoc.) SEND DUES($35.00) TO: John Schnadenberg-Membership Director 1490 Broadway, Suite 1, Chesterton,IN 46304 _ Ph.219-926-2222' *PLEASE NOTE NEW ADDRESS* 2015 I.S.C.A. DUES - $35:00 MEMBERSHIP APPLICATION Only one $35.00 fee required for membership per community. If your assistant or foreman needs a membership card,please note ori your application form*. CITY/TOWN: !Att� hulffitn� (n - NAME: o��► u1'il {l (fir, I E-MAIL: ��1�,�T l 1�1�u'� ►�i .1 fl.(?/1L� BUSINESS ADDRESS: BUSINESS PHONE: 3Ij FAX# Iy1` 3 `c X65 DUES ENCLOSED: 35 CLAIM FORM: RENEWAL: ✓ NEW MEMBER: *ADDITIONAL,MEMBERSHIP CARD (NAME) **Call or send with this registration your suggestions for topics at this year's convention. Form W-9 Request for Taxpayer Give form to the (Rev.October 2007) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax return) CM Indiana Street Commissioner' s Association aBusiness name,if different from above c 0 m c Check appropriate box: 0 Individual/Sole proprietor corporation Partnership Exempt CL c Limited liability company.Enter the tax classification(Disregarded entity, =corporation,P=partnership) 0 -_------- ❑ p - payee I- 52 Other(see instructions)0 ASSOC, Ldress(number,street,and apt or suite no.) Requester's name and address(optional) a � 1301 Lafayette Avenue w City,state,and ZIP code CL W Lebanon IN 46052 List account number(s)here(optional) co I Taxpayer Identification Number IN Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals,this is your social security number(SSN). However,for a resident i I alien, sole proprietor, or disregarded entity,see the Part I instructions on page 3. For other entities, it is your employer identification number(EIN). If you do not have a number,see How to get a TIN on page 3. or 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 enter. 3 7 1 1507456 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. 1 am a U.S.citizen or other U.S,person(defined below). Certification 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 abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement(IRA),and generally, payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of Here U.S.U.S. erson 0 4 � ff Date A .General Instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S.person if you are: Section references are to the Internal Revenue Code unless • An individual who is a U.S. citizen or U.S. resident alien, otherwise noted. • A partnership, corporation, company, or association created or Purpose of Form_ organized in the United_StateS:Or-under-the laws'of the.United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number(TIN) • An estate (other than a foreign estate), or to report, for example, income paid to you, real estate • A domestic trust(as defined in Regulations section transactions, mortgage interest you paid, acquisition or 301.7701-7). abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a contributions you made to an IRA. trade or business in the United States are generally required to Use Form W-9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W-9 requesting it(the requester) and,when applicable, to: has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct(or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a 2. Certify that you are not subject to backup withholding, or Partnership conducting a trade or business in the United States, fY y 1 P 9 provide Form W-9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a, income. U.S. person, your allocable share of any partnership income from The person who gives Form W-9 to the partnership for a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note.If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases: substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity, Cat No.10231X Form w-9 (Rev.10-2007) VOUCHER NO. WARRANT NO. ALLOWED 20 I.S.C.A. Membership IN SUM OF$ 1409 Broadway, Suite 1 Chesterton, IN 46304 $35.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 43-553.00 $35.00 1 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 Fria ,A464qO 15 W ` �eet ommisslor�eJr 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)) 02/06/15 $35.00 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