185732 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 364177 Page 1 of 1
ONE CIVIC SQUARE ESTHER G FOGLE
CARMEL, INDIANA 46032 TRUSTEE OF THE ESTHER G FOGLE TRUS CHECK AMOUNT: $34,450.00
1921 MYSTIC BAY COURT CHECK NUMBER: 185732
INDIANAPOLIS IN 46240
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
920 4470602 34,450.00 136TH /KEYSTONE R -O -W
t'
MEDIATED SETTLEMENT AGREEMENT
Re: City of Carmel v. Esther G. Foele, Trustee
On April 28, 2010, the parties mediated the pending matter and reached a
settlement. The City of Carmel agrees to pay, and the Defendant, Esther G. kogle,
Trustee, agrees to accept the suui of $63,250.00 as a full and complete settlement of all
pending claims resultuig from the exercise of the power of eminent domain by the City of
Carmel over real estate owned by the Defendant. The parties acknowledge and agree that
they sliall cause to be executed any and all documents required to convey fee title to the
real property described in the complaint filed in this cause. The Defendant represents
that there is no mortgage lien against the property. So agreed this 28 day of April, 2010.
City of Carmel Esther G. ogle,T ru9te
Acknowledged:
Alwnsend, Attorney for Carmel
Bose McKinney Evans
111 Monument Circle, Ste. 2700
Indiana Solis, IN 46204 w J
Gord rr B rs, A rney for Esther rogle, Trustee
P.O. Bo 27
Noblesville, IN 46061
Form W-9 Request for Taxpayer Give form to the
(Rev. October 2007) identification Number and Certification
requester. Do not
send to the IRS.
Department of the Treasury
Internal Revenue 5ervioe
Name (as shown on your income tax return)
Esther G. fogle, Trustee of the Esther G. Fogle Revocable Trust Agreement dated March 24, 1995
m Business name, if different from above
CL
C
0
d c Check appropriate box: VI Individuai1S01e proprietor Corporation Partnership Exempt
p0
Limited liability company. Enter the tax classification (D--disregarded entity, C= corporation, P= partnership) 11- payee
is
LS Other (sea instructions)
C Address (number, street, and apt. or suite no.) Requesters name and address (optional)
a. o 1921 Mystic Bay Court
0 City, state, and ZIP code
y Indianapolis, IN 46240
List account number(s) here (optional)
V' Taxpger Identification Number IN
Enter your TIN In the appropriate box. The TIN provided must match the name given on Line 1 to avoid Soeiet security nw -ik--
backup withholding. For Individuals, this is your social security number ISSN). 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 (UN). If you do not have a number, see Now to get a TIN on page 3. or
Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose Employer identificabon number
number to enter.
CM 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).
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 4.
Sign Signature of Date i>
Here U.S. parson t-�-(-
General instructions Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Intemal Revenue Code unless a A individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
e A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) a An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate e A domestic trust (as defined in Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701 -7).
abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA. trade or business in the United States are generally required to
Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding W.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
provide Form W -9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on Its allocable share of net income from the partnership
Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W -9. The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10 -2007)
Prescribed by Stale Board of Accounts City Form No 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Esther G. Fogle, Trustee of the Ester G. Fogle
Re vocable Trust Agree dated 3 -24 -95 Purchase Order No- N
Terms
Nobl esville IN 46060 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05119110 NA 07 -08 Keystone Parkw
136th Street Just Comaensation Land Cost
Land Cost $34, 450.00
Parcel 89
Please deliv this ch eck to
Jerem Kashma at City of C armel E nginee r's Office
w
Total $34,450.00
I hereby certify that the attached invoice(s), or bills(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
Esther G. Fogle, Trustee of e Ester
Fog le Revocable T Agreement dated 3- ALLOWED 20
IN THE SUM OF
Noblesvilie IN 46060
34,450.00
ON ACCOUNT OF APPROPRIATION FOR
Esther G. Fogle, Trustee of the Ester G. Fot
PO# or INVOICE NO. ACCT /TITLE AMOUNT Board Members
DEPT.#
NA 4470602 $34,450.00
1 hereby certify that the attched 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
24 -May 20 10
`a34,450.00 Signature
Cost distribution ledger classification if City En
claim paid motor vehicle highway fund Title