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Home My WebLink About312255 06/09/2017 �'4�W C,yMf' v, CITY OF CARMEL, INDIANA VENDOR: 371723 ONE CIVIC SQUARE RYAN HORINE CHECK AMOUNT: $**.....320.00* ;M rq; CARMEL, INDIANA 46032 9310 RED MAPLE LANE CHECK NUMBER: 312255 «oH G°' FISHERS IN 46038 CHECK DATE: 06/09/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4341992 CK REQ 320.00 SECURITY SERVICES $ o0 k \ § o z / 2 / 2 E 2 g a o o w 2co j A $ _ 0 % o A g o E 7 0 \ \ 2 q co� � CD ( -0 o q � /3 2 k # m = 0 2 $ C) $ n / \ / \ m 0 OD / j / 7 --IT 2 k a \ CL \ 2 0 2 p p Z 0 2 E § \ 2 7 / D ( a f e a k & / j A CD ° o % 3 > Q k / _ + R � 7 / 2 C- 3 ® \ _ E $ q @ CD(n CD m � CL 7 ) ƒ / � m CD 3 2 k 2 \ k \ = S C M 9 k m I S.\ / § 2 k / C) \ � ° C | § / F a 0 0 • i Folin W'9 Request for Taxpayer Give Form to the Department°m"' 20'4' Identification Number and Certification �Qq °o not Int oenueeSe=e ry send to the IRS. 1 Name(as shown on your inane tax return).Name is required on this line;do not leave this line blank. Ryan Keith Norine C%i 2 Business name/disregarded entity name,if different from above o 1 ka C3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to 0 ❑✓ Individual/scle proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/eState thin entities,not individuals;see csingle member t1C itutructions on page 3y �. ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P--partnership)► Exempt Payee code(if any) `o Note.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 the tax classification of the single-member owner. code(it any) 0. ❑Other(see instructions)► � r nb itlo ad'°•u.s� b Address(number,street,and apt.or suite no.) Requester's name d address(optional) y 9310 Red Maple Lane 6 City,state.and ZIP code Fishers,IN 46038 7 List account number(s)here(opts 59*1111111 Taxpayer Identification Number(TIN) Fater 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(SSN).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(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 ErnPloyer Identificationruumbar guidelines on whose number to enter. ITT-T Ceri fication Under penalties of perjury,)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 fort(if any)indicating that 1 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 retum.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 sigrseaxeof Here U.S person e- Date► G! - w r General Instructions •Form 1098(hone mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the Intemai Revenue Code unless otherwise noted. .Form 1099-C(canceled debt) Future developments.Information about developments affecting Foran W-9(such .Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.9ov1hvg. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information N 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 whWIdfng.See 141W Is backup withhofng?on page 2. which may be your social security number(SSM,individual taxpayer identification number(MM.adoption taxpayer identification number(ATIM,or employer BY signing the fulled out corm,you: Weatification number(EIM,to report on an information return the amount paid to 1.Certify that the TIN you are giving is correct(or you are waiting for a number you,or other amount reportable on an information return.Examples of information to be issued), 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 •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 •Form 1099 MI5C various any partnership income from a U.S.trade or business is not subject to the ( types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-8(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 brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-$(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third Tre transactions) Cat No.10231X Form W-9(Rev.12-2014) i ............... .. Carmel ► Clay Parks&Recreation CHECK REQUEST Date: June 5,2017 Check payable to: Name: Ryan Horine Address: 9310 Red Maple Lane City,State,Zip_ Fishers,In 46038 _XX Mail check to payee Return check to requestor Check Amount:$ 320.00 Date Required: PISA P Purpose of Check: Security Services 6/4/17 8 hours @$40 ea. Supporting documentation or invoice(s)MUST be attached. To be paid from: (� PO#(if applicable) Budget account-GL# 1091-4341992 Budget Line Description Security Services Requested by(print): Paula Schlemmer� n� '� , Requested by(signature/date): `F'�(�,�1�[.�.Y r m{'Yl P1(� 6/5/17 Approved by(print): Audrey Kostrzewa Approved by(signature/date) Form recreated 3/10/15(Business Services)