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Home My WebLink About305427 11/28/16 (9, CITY OF CARMEL, INDIANA VENDOR: 357330 ONE CIVIC SQUARE INDIANA ASSOC OF THE DEAF CHECKAMOUNT: S""•1,125.00'CARMEL, INDIANA 46032 PO BOX 551024 CHECK NUMBER: 305427 INDIANAPOLIS IN 46205-5524 CHECK DATE: . 11/28/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4340800 7 1,125.00 ADULT CONTRACTORS Voucher No. Warrant No. Indiana Association of the Deaf Allowed 20 PO Box 551024 Indianapolis, IN 46205-5524 In Sum of$ $ 1,125.00 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members Dept# 1096-35 7 4340800 $ 1,125.00 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 November 15, 2016 1PAk&WA" Signature $ 1,125.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund s EIVED J U L 142016 G e Form to&se Font, W-9 Request for Taxpayer uester.Do not (Rev.December2014) Identification Plumber and Ce ff atlon s nd to the IRS. Department of the TressM Internal Revenue Service 1 Name(assAn on your income return).Na a Isuired on this ;do not leave this tine bl k. 7 t�C�,�Q �dCl�w7'idrr ®� r N 2 Business name/disregarded entity name,if different from above m rn M 4 Exemptions(codes apply only to 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: certain entities,not individuals;see C ❑Individual/sole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trustfestate instructions on page 3): ID C single-member LLC Exempt payee code(d any) y ❑Limited liability company.Enter the tax classificalion(C=C corporation,S=S corporation,P=partnership)► o Exemption from FATCA reporting `o Note.For a single-member LLC that is disregarded,do not check LLC:check the appropriate box in the line above for code(if any) a the tax classification of the single-member owner. vppb"to r_couvr ff—M .d Orad.e.U.S.) p, u Other(see instructions)11- 5-61[G 6 Add r s(number,street,and apt.or suite no.) Requester's name and address(optional) 6 City state, nd ZIP code 7 Ust account numbehere(optional) Mfil 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 generally yourar security number(Sag).however,fora _m -+-1-1--i--' resident alien,sole proprietor,or disregarded entity,see thea 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 identirrcatfon 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 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 S. 0 4 n Sign signature of Cate► v- / Here U.S.person► •Form f098(home mortgage Interest).1098-E(student loan interest),1096-T General Instructions (tultlon) 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 wwwjrs.gov/tw9. Use Form W-9 only N you are a U.S.person(including a resident ellen),to Purpose of Form provide your correct TIN. An Individual or entity(Forth W-9 requester)who Is required to file an information if you do not rotum Form W-9 to the requester with a TIN,you might be subject retum with the IRS must obtain your correct taxpayer Identification number(TIN) to backup withhoWng.See What Is backup withholding?on page 2. which may be your social security number(SSM,individual taxpayer identification By signing the tilled-out form,you: number(RIM,adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving Is correct(or you are wetting for a number Identification number(Elite,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 1098-INT(Interest eamed or paid) 3.Claim exemption from backup withholding If you are a U.S.exempt payee.If •Form 1099-DN(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 1098-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 certain other transactions by 4.Certify that FATCA code(s)entered on this form(d any)Indicating that you are broksm) exempt from the FATCA reporting.Is correct.Seo Whet Is FATCA reporting?on •Forth 1099-5(pnops@ds from real estate transactions) page 2 for further information. •Form 1098-K(merchant card and third party network tiansecdorm) Cat.No.10231X Form W-g(Rev.12-2014) aaAAsfonoftociaic Deaf PO Box 551'024.1nd anIN 4Ei205 5'524 NOV 12016 I r Treasurer@iadhoosiers.org g _ Tel 317-543=7805 Fax otups755egi76@hpeprint.com INVO!CE00007 11.8,2016 BILL TO SHIP TO INSTRUCTIONS Monon Cmnty Ctr Indiana Association of the n/a 1235 Central Park Dr E Deaf Carmel,IN 46032 PO BOX 551024 317.573.5237 Indianapolis,IN 46205- jhill@carmelclayparks.coin 5524 QUANTITY DESCRIPTION , 9 ASL adult education class $125.00 $1125 SUBTOTAL $1;125 Purchase -------- Description SALES TAX. n/a P.O.# roti Y z � P 0(v -- ----- ---------- . .. SHIPPING&HANDLING n/a G;L.#. 109& -o35 — _c13Y0= Budget. TOTAL0613Y 10'32 24i9 5= Line Descr , aye,ra 14 Purchaser. Date it /6 Approval Date 1 r o r& Thank you for your business!