312382 06/13/17 CITY OF CARMEL, INDIANA VENDOR: 365226
ONE CIVIC SQUARE FABULOUSLY FUN COMPANY CHECK AMOUNT: $*******300.00*
?4 CARMEL, INDIANA 46032 ADRIENNE OGLE CHECK NUMBER: 312382
16425 OAK MANOR DRIVE CHECK DATE: 06/13/17
WESTFIELD IN 46074
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
851 5023990 1756 300.00 OTHER EXPENSES
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fabulou company.com
Carmel Public Safety Day
St.Vincent's Hospital
Saturday, September .16, 2017 from 11 am - 2pm
1 cart with 1 airbrush artist @ $125/hr x 3 hours
$375 - $75 discount for the Carmel Police Dept. _ $300 Total
PayPal accepted.Please ask for a Paypal invoice.Checks made payable to Fabulously Fun Company.
Thank you for hiring Fabulously Fun Company!
Sincerely, Adrienne Maynard
16425 Oak Manor Drive •Westfield, IN 46074
317-319-3610
www.fabulouslyfuncompany.com
Form W-9 Request for Taxpayer Give Form to the
(Rev.December 2014) Identiflcatton Number and Certification requester.Do not
send to the IRS.
Internal Rev.01="
1 Name(as shown on your income tax return).Name is required on this line;do not leave this I blank.
v' ` n . int 941Yl
N 2 Business name/dWagerded entity name,it different from above
COMMPW
3 Check appropriate box for federal tax classification;check only orw of the following boxes: 4 Exemptions(codes apply only to
C certain entities,not individuals;see.
IndividuaVsole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate instructions on page 3):
single-member LLC Exempt payee code(it any)
❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
Nob.For a singb-member LLC that is disregarded,do not check LLC;check the appropriate box in the Ilre above for Exemption from FATCA reporting
yr the tax cl�sificatbn of the single-member owner. code(if any)
gF]Other(see instructions)► raw..a.aoauner rr ra OMda m•US.)
6 Address(number,street,and apt.or suite no.) Requester's name and address(optional)
1 ;)LDa Mario r-
ft City,state,and ZIP code 7431 07
7 List account nu )here
EM141111 Taxpayer Identification Number IN
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social sswrity
backup withholding.For individuals,this is generally your social security number(SSN).However,fora FT7
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 Employes motion nun*w
guidelines on whose number to enter. FiF(o] _ ' 1 � O
1 , 1��
gMUM Certification
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waking 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)1 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 instriwbons.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 riot 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 sior tr,rs of /
Here U.S.person D, Debs►
General Instructions •Form 1098(home mortgage interest),1096-E(student ban interest),1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future dsvek*awnts.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.gov/Aw9.
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 Ifyou 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 2.Gerrity that you are not subject to backup withholding,a
returnsanclude,but are not limited to,the following:
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
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
•Forth 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this forth(K any)indicating that you are
brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231X Form W-9(Rev.12-2014)