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Home My WebLink About304292 10/20/16 �i u'C,AMR CITY OF CARMEL, INDIANA VENDOR: 371243 ONE CIVIC SQUARE LIGHTBOX PHOTO ACADEMY LLC CHECK AMOUNT: $*******245.00* CARMEL, INDIANA 46032 3916 CREST POINT DRIVE CHECK NUMBER: 304292 WESTFIELD IN 46062 CHECK DATE: 10/20/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4340800 100316 245.00 ADULT CONTRACTORS Voucher No. Warrant No. J' Lightbox Photo Academy, LLC Allowed 20 3916 Crest Point Drive Westfield, IN 46062 In Sum of$ $ 245.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1096-35 10/3/16 4340800 $ 245.00 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 October 12, 2016 PAdU"WXLU Signature $ 245.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund Lo-w CEI y E1J qP OCT 10 2016 LIGHTBOX PHOTO ACADEMY BY: —741 Invoice Lightbox Photo a e. ' 1-0/.3/:16 Company: Academy, LLC Contact Name: Michael Godek Products/Work: )r. Photographers Contact Number: 317-407-9198 Class Description of Work Qty/ Hrs Unit Price Sub Total J.... Photographers Class 7//3 7 $35.00 $245.00 Purchase Description Cn4m;-Azy- gpmrnk P.O.# lDY?S P o G.L.# 10 G— 5 - 3Y Budget Line Descr Purchaser Date ry Approval L1,l�nU.1,W Datel1 ;(� Payment Terms Approved by: To..be made payable to Light ax,Photo Academy. Name: Michael Godek -= Ih 39 I C Greek- "Poi Y - �1eS-��-►eld ( �1 .��,0102 Page 1 of 1 Form " Request f®r Taxpayer Give Form to the (Rev.December Treasury Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Intemal Revenue Service 1 Name,(as shown]]on our income tax re .Nam is required on this line;do not leave this line blank. Llah Cu e✓-'L N 2 Business n4&disiregarded a tity name,if different from above d rn to n C eck appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to ° Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate certain entities,not individuals;see rn c Ingle•member LLC instructions on page 3): o Exempt payee code(if any)_ 0 ❑Limited liabllfty company.Enter the tax classification(C--C corporation,SS corporation,P=partnership)► `o 9Note.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 c the tax classification of the single-member owner. code(f any) tl— ❑Other(..a in5tr..110rms)► (AA066s tot aunis meinta/neo ouhioe the U.S.) V 6 Address( mber street,and apt suite no.) Requester's name and address(optional) XT W 6 Cit ,state and ZIP code cry e <<�� '/V ��v6 2 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(page However,for a -m - resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page S.For other entities,it is your employer identification number(EIN).If you do not have a number,see Now 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. � I 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 net 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 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 3. Sign Signature of / Here U.S.person► Date► �'LrS�T✓ 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/iw9. Use Form W-9 only If you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. i An individual or entity(Form W-9 requester)who is required to file an information II you do not return Form W-9 to the requester with a TIN,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 j •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 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 1 •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)Indicating that you are brokers) exempt from the FATCA reporting,is correct.See Mat is FATCA report/ng?on ! - •Form 1099-S(proceeds from real estate transactions) page 2 for further information. ! •Form 1099-K(merchant card and third party network transactions) i I Cat.No.10231X Form W-9(Rev.12-2014) . i III///