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Home My WebLink About312234 06/09/2017 CITY OF CARMEL, INDIANA VENDOR: 371721 CHECK AMOUNT: $"'"*""*320.00* 9 ONE CIVIC SQUARE PATRICK CLENNON 11017 GEIST WOODS NORTH DRIVE CHECK NUMBER: 312234 CARMEL, INDIANA 46032 INDIANAPOLIS IN 46256 CHECK DATE: 06/09/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT SECURIDESCRIPTION E SERV CES 1091 4341992 CK REQUEST 320.00 0 o -u 0 2 (D2 O 7 _ e 2 -S > z � 0 n q ego 13 $ w O A CD CD £ # ƒ 0 w k k - e m o ( A § 0 2 9 2 ® E a 2 m 7 K ƒ $ > ƒ § 2 20 $ n # \ k p q / § / 0 q ® E 7 2 $ 0 a ® 0 / f 2 6 9 . 0 Z ƒ C) \ 3 2 R C-D ] \ # nm m CDCD \ ® ® cr \ $ \ G 3 0 q a CD 0 2 E m - n / e � r 2 S 2 - @ § E(n CD ; J » 2 % \ S 2 2 0 k k 0 7 9 & / m m° a CL 2 m oq g_ g ƒ $ o � CL o / k § | 0 o Form W-9 Request for Taxpayer Give Form to the (Rev.December2o,a) Identification Number and Certification requester. I not DepartmentoftheTreasury send to the IRS. Internal Revenue Service 1 N (as shown on your ipcome tax return).Name is required on this line:do not leave this fine blank. Tt>ZI�)� ICOR -L- ifLF,1J1JOt} N 2 Business nameldisregarded entity name,if different from above m rn C 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to certain entities,not individuals;see IndividuaUsole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Tnist/estate instructions on page 3): a c single member LLC Exempt payee, ( y) o ee code d an ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► :9 Exemption from FATCA reporting Q 2 Note.For a single-member LLC that is disregarded.do not check LLC;check the appropriate box in the line above for V; the tax classification of the single-member owner. code(if any) c O ❑Other(see instructions)► (AaPzes to accounts mednfNed aA&Va ft u.SJ !E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) U) 6 C, ,state,and ZIP code N I AJDiptPAPoLAS , j 1�(,ZS6 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 los generally your social security number(SSN).However,for a a resident alien,sole proprietor,or disregarded entity,see the Part 1 instructions on page 3.For other -W 7 � - 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 lderrtificarmn 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(it any)indicating that I am exempt from FATCA reporting is correct. Certification kudruetions.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 ORA),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 person ,/ Here U.S.U.S.person► Date► y� •Form 1098(home mortgage interest),1098-E(student loam interest),1098-T General Instructions (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 Form W-9 only ff you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Fant W-9 requester)who is required to file an information If 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(ATS,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 am 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-DN dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of l m9 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 1099-13(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 What is FATCA reporting?on •Form 1 o99-S(proceeds from real-tat vwM,actions) page 2 for further information. •Form 1099-K(merchant card and third Alir network transactions) Cat.No.10231 X Form W-9(Rev.12-2014) Carmel • Clay Parks&Recreation CHECK REQUEST Date: June 5,2017 Check payable to: Name: Patrick M Clennon Address: 11017 Geist Woods North Drivee City,State,Zip Indianapolis, IN 46256 _XX Mail check to payee Return check to requestor Check Amount:$ $320.00 Date Required: ASAP Purpose of Check: Security Services 5/28/17 8 hours$$40.00 ea. Supporting documentation or invoice(s)MUST be attached. To be paid from: (�Uc�2 PO#(if applicable) Li t`V Budget account-GL# 1091-4341992 Budget Line Description Security Services Requested by(print): Paula Schlemmer ) Requested by(signature/date): SIJc t/�(�(,��'y(,YhP�t/ G-5, Approved by(print): Audrey Kostrzewa Approved by(signature/date) Form recreated 3/10/15(Business Services)