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Home My WebLink About244041 04/08/15 y�..[�gMfi . CITY OF CARMEL, INDIANA VENDOR: 369240 j i'. ONE CIVIC SQUARE ROBERT E PATTERSON CHECK AMOUNT: $*****1,500.00' CARMEL, INDIANA 46032 631 MOHAWK COURT CHECK NUMBER: 244041 4"M,��N�o.? CARMEL IN 46033 CHECK DATE: 04/08/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4352500 1,500.00 RENT PAYMENTS Rental Invoice for 631 Mohawk Ct. Car el, In 46033 For the period from 4/15/2015 to 7/15/2015 $_4.58e-w Remit to Robert E. Patterson P.O. Box 3159 Carmel, In. 46082-3159 Form w_9 Request for Taxpayer Give Form to the (Rev.December 2014) Identification Number and Certification requester. not Department of the Treasury on Isury send to the RS. Internal Revenue Service 1 Name(as s w ony6ur incom, iirdon this line;do nolli leave this line blank. N 2 Business name/disregarded entity name,if different from above m C' 3 Chec ppropnate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to o ndividual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate certain entities,not individuals;see rn instructions on page 3): C single-member LLC Limited liability company.Enter the tax classification(C=C corporation,S=S corporation, Exempt payee code(if any) U Y P Y poradon,P=partnership)P._ p Note.For a single-member LLC that is disregarded,do not check LLC,check the appropriate box in the line above for Exemption from FATCA reporting Nthe tax classification of the single-member owner. code(if any) c Q- S ❑Other(See instructions)► _ Vwn11es to oac (u maM.ma outside mo U S I 5 Address(number,street,and a or suite of Requester's name and address(optional) W 6 Ci tate,and-LIP code --.—.---------- ---�— - --/----�--- 7 List account number(s here(optional) Taxpayer Identification Number(TIN) 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 generally your social security number(SSN).However,for a resident 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 instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. 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);and 4. The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. 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 abandonme t of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than intere nd dividends,you ar not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. ., _ Sign Signature of Here U.S.person► Date► 04/06/2015 General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.gov/fw9. Use f=orm W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity Form W-9 requester)who is required to file an information It you do not return Form W-9 to the requester with a IIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV dividends.including those from stocks or mutual funds} applicable.you are also certifying that as a U.S.person,your allocable share of ( 9 any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and cerlain other transactions by 4.Certify that FATCA codes)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form w-9(Rev.12-2014) �I 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)) Sta. 44 Rental $4,500.00 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 i VOUCHER NO. WARRANT NO. ALLOWED 20 Robert E. Patterson IN SUM OF $ PO Box 3159 Carmel, IN 46082-3159 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members I hereby certify that the attached invoice(s), or IJV�-A bill(s) is (are) true and correct and that the IJV materials or services itemized thereon for which charge is made were ordered and received except Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund