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Home My WebLink About259931 06/24/16 �y''��"� CITY OF CARMEL, INDIANA VENDOR: 370706 {> ® 3i ONE CIVIC SQUARE IMAGINATION STATION CHECK AMOUNT: $*******648.00* f. a° CARMEL, INDIANA 46032 600 NORTH 4TH STREET CHECK NUMBER: 259931 9.y`��TON_.�-0,�` LAFAYETTE IN 47901 CHECK DATE: 06/24/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1082 4343007 15 648.00 FIELD TRIPS Voucher No. Warrant No. Imagination Station Allowed 20 600 North 4th Street Lafayette, IN 47901 In Sum of$ $ 648.00 ON ACCOUNT OF APPROPRIATION FOR 108-ESE PO#or INVOICE NO. CCT#/TITL AMOUNT Board Members Dept# ; 1082-12 15 4343007 $ 648.00 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 June 15, 2016 Signature $ 648.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Invoice Updated JUN 13 2016 $648.00 due on Jun 13, 2016 Carmel-Clay Parks and Recreation ln�r �ce#000015�� ^i4 1 Jude-13il201_G_ .. 7 Customer Shawndi Walker swalker@carmelclayparks.com We appreciate your business. Special Demo is for TAF. Field Trip (Regular Child) x 108 $432.00 Field Trip (Special Demonstration) $216.00 Field Trip (Chaperone) x 15 $0.00 Sub-Total $648.00 Total Due $648 00 maglnation StationScience Center 60. �4th Street, ��fay tte I lei 4 901- ir��a@�rrrag��►a�i�n-station:org 765-420-7750 V-ze rf. es' T 3{�.ay(,,'i Give hot"id Czi f� �. for ;� i'r:)I-ill to ttlD (Itov.17cceiint,er 2014)srr ; 1iEiI -"- Yoiltresfer. Do not teparmentoftileTeaI(Ac nriication N(albew idGo _. send to the i Internal Re\'enun t:er\';CB ��' ( �, 1 Name(as sho\:vt on your income tax felunt). i.ame is required on this line;do not leave this line blank; w - ASSOci.atiorl for Space Science En ine(-rinq acidInc. ' Tech,-hr I--- 2 Business name/disregarded entity name,if different from abc:re cv Daagi.nati.o i Station - i ----- c.0• 3 Chec'r,appropriate box for federal lnx dassifcation;check only nue of the following seven boxes:C. ___T. +I f -- r ) certain entities,not individuals:sca individualisote proprietor er I C Corporation L _I S Corporation El Pzrinerslup E]TrusVestate instructions on page 3) a y s'ngle-member LLC ° , Exempt payee Code-(d anY)_._.__.._____-- Linnilcd liability company.Enter the lax c"'assiGcatien(C--C re:poratlon,S=S corporation,['=partnership) IN - o ? [tote.For a single•niernber I.LC that is disregaidcd,(to not check LLC:check the appfoprialo box in the line above for Exemption(rem FMCA reporting Mc 4 line tax classification of the sirgle-men}berovmer. code .fan a. X. Other(sec.instructions) i% Not-.fox-profit Corporation (app},c, o xo r,;,a;r,r,a;�•s:d:r::,us/ 3 6 Address(number,street,and apt.orsuite no.) Requester's name and address(optional) Uc 600 N 9th St u 6 City,state,and ZIP coda -._.._— ' Lafayett e, IN 47901 7 List account number(s)here(optional) ��, �( Taxpayer• Identification Number(TIN) � -�__�___ - Gnter your 71N in the appropriate fox.The TIN provided must match the name given an line 1 to avoid Social"security numbarV backup withholding.For individuals,this is generally your social security number(SSN).How✓ever,fora f I� resident alien,sole proprietor,or disregarded entity,see lite Part I instructions ort page 3.For oilier �—t � J_�� enfiiies,it is your employer Identification number(FIN).If you do not have a number,see Hoty fo get o T!N on page 3. or Note. If the account is in more than one name,see the instructions for line I and the chari on page 4 for Employer identification number guidelines on whose number to enter. R- ___..-....__._.__ _ _ I __�1 JjJ 9 0 1 6 --, f " Certification — ----_ ----- ...._ _--- ._......_....-._.....- ...- — —_Under __..._..__..._..-- penalties of perjury.I certify that: 1. The number shown on this forrn is Illy correct taxpayer identification number(or I ant Waiting for a number to be issued to tile);and 2. 1 ant not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenge Service(IRS)that I ant 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 FA7CA 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 abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are riot required to sign(tie certification,but you must provide you;correct TIN.Seethe instructions on page 3. Sigri Signaturo of l ere U.S. person D / �(,f' /i rr.•/� ��— Date k> t �.✓��"�+ General Instructions �� o Form 1098(home mcrlgaee interest),1098•E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless othem,se noted, o Form 1099-C(cancefed debt) Future developments. Information about developments affecting Form 10:-9(such o Form 1099-A(acquisition or abandonment of secured property) as legislation enacted alterv.e re'.ease it)is at uvtwur.irs.yovlltvg. Use Foran V-1-9 only it you are a U.S.person(including a resident alien),to Purpose of Form pro•rde your correct TIN If you do not return Foran V,%9 to the requester nitti a TIN,you afght be subject An individual or entity(Form in y requester)taxpayer y required to hie an bei(TIN) to backup twilrrho!ding.See What is backup t:rlluho!ding7 on page 2. return with the IRS mast obtain your coueci taxpayer idanGficaGon number(TIN) which may be your social security number(SS114),individual taxpayer iden,iflcation By signing the hoed-nit four,you: number(MN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(oryou are wailing for a number Identification number(EIN),to report oh an information return the amount paid to to be issued), you,or other amount reportable on an information return.Exaniptes of information 2.Certify that you are not subject to backup wilhholding,or returns include,but are not limited to,the faflo;ong: 3.Claim exemption from backup withholding if you are a U.S.exempt payee.if o Foran 1099-INT(interest earned or paid) applicable,you are also certifying that as a U.S.person,your P'iocable share of ° Form 1099-DIV(dividends,including those frons stocks or mutual funds) any partnership income from a U.S.trade or business is not subject to the o Foran 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding lax an foreign partners'share of effectively connected income,and v Form 1099-0(stock or mutual fund sales and certain other transactions by 4•Certify that FATCA code(s)entered on this form(it any)indicating that you are brokers) exempt from the FATCA reporting,is ccrrecl.See tbwat is FA TCA reporting?on v Form 1009.5(proceeds from real estate transactions) page 2 for further information, o Form 1099-K(merchant card and third party network transactions) - JSP, Form W-9(Rev.12-2014) SYJ�D5D 1.CDD