HomeMy WebLinkAbout305474 11/28/16 -
^/ CITY OF CARMEL, INDIANA VENDOR: 363136
ONE CIVIC SQUARE STUCKEY FARM MARKET CHECK AMOUNT: $*******450.00*
CARMEL, INDIANA 46032 19975 HAMILTON BOONE RD CHECK NUMBER: 305474
'+,...._..- SHERIDANIN 46069 CHECK DATE: 11/28/16
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343007 10/14/16 450.00 FIELD TRIPS
Voucher No. Warrant No.
363136 Stuckey Farm Market Allowed 20
19975 Hamilton Boone Rd
Sheridan, IN 46069
In Sum of$
$ 450.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept#
1081-99 10/14/16 4343007 $ 450.00 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
Signature
$ 450.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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. _Taxpayer Identification Numbgff N
Enter you:r'nN in the appropriate box-The TIN provided must matrh the name given on fine 1 to avoid SocialwaLftnurn1wr
backup withholding.For individuals,this is generally your social security number(SSM.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(FIN).If you do not have a number,see How to get a 01] Ui 4 F
nN on page 3. ' or
Note.if the account Its In more than one name,see the Instructions for fine I and the chart on page 4 for
guideffnes on whose numberto 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. lam not subject to backup withholding because:(a)1 am exempt from backup withholding,or(b)I have not been notified by the Internal.Rovenue
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 arty]indicating that I am exempt from FATCA reporting is correct
Certification ftstructions.You must cross ouf1kn 2 above If you have been notified by the IRS that you are currently subjeetto backup withholding
because you havea reall interest and*Mends on your tax return-For real estate transactions,Item 2 does not apply.For mortgage
Interest paid,acqu=oi W on property,cancellation of debt contributions to an Individual retirement arrangement ORA),and
ur I
generally,payments,other an tXendfid s,you are not required to to the certification,but you must provide your correct TIN'See the
page
Instructions on
Sign s Signal ureet
Here y wkpmonip- Data�
•Form ImortgagGinterml).10M-F(studentbart lntems[�10WT
General-lnstructioF4 LIL gum=)
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Section referencesCode wow otherwise noted. *Form l(199-C(caimcelsddebt}
Future developmerds.Infornialion about developments affecting Form W-9(such Form 100A Ocqtdsftn or abandonment of secured property)
as le 0 sk rdDn enacted dW we release it)is at www-ft&govWWQ. Use Form W-9 only IF you are dI.I.S.person(meltiding a resident affen).to
Purpose of Fann provide your conect TIM
An hdividual or entity form W-9 requester}who is required to 1199 an information ffyou do not Mim Form W9 to ft mqmfw wfth a 77N,jw mightbe subject
return with the IRS mustobtain your conect taxpayer identification number MW to backup ufth.ffM See MW is backup witlMolding?an page 2.
wrack may beyour sociallsec pity nurnber(SSN),urdividi>iil taamayer idgntdeGrttan By&WMg#w filled-out tw.n.you:
raanber QTiN),adoption taxpayer iderihT ition number(ATIM,or employer i.Certilyttadthe'riN youaregfift is correct(or you wammitim fora rvxnber
you,a otheramotant reportable ore an inforrnaitai retwi.Examples of =
n to be issued).mum Include.but are not limited to,ft following: I Certify#nd you we not subject to bacimp withholding,or
a Form[099-NT(interest earned or paQ 3.Claim acemplim from backup withholding if you am a U.S.exempt payee.If
applicabb,you are also certifying that as a U.S.person,your allocable share of
&Form 1 ODD-DIV(dividends,including those from skxft or mutual funds) ;iny partnership Income from a U.S.trade or business is not subject to the
•Form I OWMISC Wow types of income,pff7M,awards.or gross proceeds) withholding in an foreign partnere sham of effectively connected MoDw.and
•Form 1099-8 Mock or mutual fund sales and certain other transactions by 4-Certify that FATCA codes)entered on this form M arry)indicating that you we
brokers) exempt from the FATCA mpwft Is mffecL See MA b FAMA rep~-on
•Form i0W-S{proceeds from real estatetrarsaqtlons) page 2 for further hilbirration.
•Form 1099-K(merchant card and third party network Unnsactlim)
Cat Nm 10231X Form W-9 FW.12-2014)
,s://Pdfnm.com/document/e&tor/2 10/10/2
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Bill To: Carmel Clay Parks Camp Program
1235 Central Park Dr. E NOV 14 '6'016
Carmel, IN 46032
BY: i
- --- Attn:-- Jennifer-Hammons _-
School Tour of Stuckey Farm Orchard on Friday 10/14/16
60 students @$7.50 ea = $450.00
ota nue ,r _� :y $435000
a,
--- =
Please�Re �ZlStuc_keyaG Q chard —_- -
997k5 Hamilton Boone�Rd.
reYid n IN 4°60-669
khankYou,
Ta m Tour Coordinator
317 752 2405
W-9 included