185917 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 364202 Page 1 of 1
ONE CIVIC SQUARE PILGRIM LUTHERAN CHURCH
G' CARMEL, INDIANA 46032 10202 N MERIDIAN ST CHECK AMOUNT: $66,200.00
INDIANAPOLIS IN 46290 CHECK NUMBER: 185917
CHECK DATE: 5/26/2010
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 R4460500 19795 66,200.00 RIGHT OF WAY
I`
Associated Ri ht �y Servic
TO: Jill Newport
FROM: Allen D. Mcl ~earin
RE: Project: West 106' Street from Michigan Road to Ditch Road
Parcel: 9
Owner: Pil��rim Lutheran Church of Indianapolis, Inc.
DATE: May I I, 2010
The above parcel is secured and ready for processing Ior payment as described in the
enclosures.
The following documents are enclosed:
Uniform Property Acquisition Offer
Receipts of Offer
Acceptance of Offer (original) (included in Uniform Property Acquisition Offer)
Warranty Deed (r
Casement Agreement l) C
W -9 form (original)
h� amount of Id offer w as_$C.6 2. 0 Of this amount, $49,400.00 was for the fee
simple acquisition. The balance, $16,800.00, was for the permanent easement.
.If you need additional information, please let me know.
1311 N. Arlington Ave- Suite 209 Indianapolis. Indiana ^.6399 (3 1 71 322 -0 ?89 FAX: (3171 322 -0��9 j
1
JAmi s BRAINARD, MAYCH
UNIFORM PROPERTY ACQUISITION OFFER
DATE: October 17, 2009
Pilgrim Lutherwi ChUrah of PIZOJECT: 106 Street fi•orn Ditch Road to
Indianapolis, Inc, Michigan Road
c/o Al Goerterniller PARCEL: 9
10202 North Meridiwi Street FEE SIMPLE, PAID VIAL 0.3980 acres
Indianapolis, IN 46290 PERMANENT EASEMENT: 0,2080 acres
Pilgrim Lutheran Church of
Indiwapolis, Inc.
c/o Gerald Powell
10202 North Meridiafi Street
hiclianapolis, IN 46290
Pilgrim Lutheran Church of
hldianRpolis, Inc.
c/o Darrell Pike
11123 Peppernii11 Lane
Fishers, IN 46037
`I "he. CITY OF CA.I7.:M L, INDLANA is authorized by Cndiana law to obtain your land for certain
public purposes.
The City of Carmel needs your property fora public improvemcnt In this instance, the City of
Carmel nceds your land for the public inlprovemcnt project on 106' Street from Ditch Road to
Michigan Road turd needs to tale the land as described on the attached land plat and legal
description. See Exiubits A and Exhibits }3,
It is our opinion that the fair rnEaket value of the property we want to acquire from you is
$66,200.00 and, therefore, we offer you $66,200.00 for the above described property. You have
thirty (30) days from this date to accept or reject this offer, If you accept this after, you may expect
Payment in full within ninety (90) clays a:her signing the documents accepting this offer and,
executing the appropriate instruments, and provided there arc, no dif in clearing liens or
other problems with He to land. Possession will he requires! thirty (30) days after you have
received your payment in full,
ONe Cnric SQUAT s, CARN -W., IN 46032 UFi;io- 317.571,2 FAX 317.571.2.139
I;nIAn en };in ^u:ring¢rci rmcf.En.gnv
i
HEIZ.h' IS A BRIEF SUMMARY OF YOUR OPTIONS AND LEGALLY PROTECTPD JUGHTS:
1. By law, the City of Cannei is required to make a good faith effort to purchase your property.
I
2. You do not have to accept this offer and the City of Carmel is .not required to agree to your demands.
1 However, if you do not accept this off cr, and we cannot come to an agrcernent on the acquisition of your
property, the City of Carmel has the right to Iile suit to condenxn and acquire the property in the county in
which the real estate is located.
4. You have the right to seek advice of anattorney, real estate appraiser, or any other person of your choice
on this matter.
5. You may object to the public purpose and necessity of this proiect.
G. If the City of Camel tiles a suit to coridonln and acquire your property,,and the court grants its request
to condemn, the court will then appoint three appraisers who will make an independent appraisal of the
property
to be acquired.
7. If we both agroc with the court appraisers' report, then the matter is settled. However, if either of us
disagrees with the appraisers' report to the court, either of us has the right to ask fora trial to decide-
what should be paid to you for the property condemned.
S. If the court appraisers' report is not accepted by either of us, then the City of Carmel has the legal
option of depositing the amotmt of the court appraisers' evaluation with the court. And if such a deposit is
made with the court, the City of Carmel is legally entitled to immediate possession of the property. Yogi
may, subject to the approval of d)e court, snake withdrawals from the mnount deposited with tile, court.
Your withdrawal will in no way affect the proceedings of your case in court, except that, if final judgment
awarded is less than the withdrawal you have: made from the amount deposited, you will be required to
pay Back to the court 1_])e, amount of tlic withdrawal in excess of the airnount of the final judgment.
9. The trial will decide the full amount of damages you are to receive. Both of us will be entitled to present
legal evidence supporting our opinions of the value of the property, The court's decision may be more
or less thaii this offer. You may employ, at your cost, appraisers and attorneys to represent you at this time
or at arty time during the course of the proceeding described in this notice.
10. If you have any questions concurring this matter, you may contact Associated Right or'V` :iy Services lit
1311 N. Arlington Avenue, Suite 209, Indianapolis, Indiana, 4621.9, or telephone 322 -0489.
Ifyou decide to accept this offer of $66,200.00, sign your name below and mail this fbim to the address indicated
above. An additional copy of this rifer has becll provided for your file.
ACCEPTANCE OF OFFER
Pilgrim 7 udicran Church of Indianapolis, Ine., landowner of the abovu-described property of intel'est Ill
proper y, h °reby accept the offer of $66,200.00 made by the City of Carmel on this day of
L-- z -01 0..
BY 4v�_
Printed
P12
'title
,z5
r •+via i��
T" n
11 t t 7
a•a t E
"r* NOTARY'S CERTIFICATE
a:
COUNTY OP,�,.�
Zor o
Subscribed amid sworn to before me this day of Zk.
My commission expires: 5��3 Lois
r
r�
County of residence:��.
L
Printed
This offer was made to the mier, .Pilgrim LUOICran Church of Indimiapolis, Inc, of Hamilton County, Indiana,
on the day of mm 2009,
A er
Allen D. McFeari i
Acquisition Specialist
Agent, City of Carmel, Lidiana
Offer made by certified mail 7009 141.0 0000 1956 1028 (Goertemiller)
7009.1410 0000 1956 1035 (Powell)
7009 1410 0000 1956 1042 (Pike)
I
I
i
EXHIBIT "A"
OWNER; Pilgrim Lutheran Church of Indianapolis, Inc.
DEElD RECOM 200200072725
IIAMILTON COUNTY PARCEL NO.; 32. 17.13- 06.04 -05•- 001.000
Permanent Easement
A part of the southeast quarter of the southeast. quarter of Section 6, Township 17 North,
Rangc 3 East in Clay Township, Hamilton County, Indiana, said part being more
particularly described as follows:
Commencing tit the southeast comer of said quarter quarter section; thertce South 89
degrees 42 mirnites 30 seconds West (Indiana State Plane Coordinate System, Isasl lono),
along the south line of said quarter quarter sectio), a distance of 1,330.35 feet to
southwest comer of said quarter quarter section; tbcnec North 00 degrees 16 minutes 40
seconds Fast, along the west line of snid quartet' quw'ter seotion, a disinnee of 67.84 feet;
thence North 89 degrees 43 minutes 51 seconds Exist, a distance of 56,04 feet to the
POINT OF BEGINNING of this description; thence continuing North 89 degrees 43
minutes 5I seconds Ettst, a distance of365.53 feet; thence South 80 degrees 16 minutes
07 seconds East, a distance of 101.54 feet; thence North 89 degrees 42 inimrtes 30
seconds East, parallel with the south line of snid quarter quatior section, a distance of
373,40 feet to the westerly boundary of a 2.994 acre parcel as described in lnstnanent.
Number 200100054751 in the Office of the Recorder of Hamilton County,.lndianrt;
thence North 00 degrees 02 minutes 45 seconds East, along; said westerly boundary, u
distance of23.78 feet; thence South fib degrees 42 minutes 07 seconds West, a distance
of 4 feet; thence South 89 degree 44 minutes 57 seconds Vilest, a distance of 224.18
feet; thence North 8-3 degrees 02 minutes 34 seconds West, a distance of 160.28 feet;
thence South 89 degrees 42 minutes 17 seconds West, a distance oi'391.04 feel; thence
South 68 degrees 59 minutes 49 seconds West, a distance of 27.73 feet to tine point of
beginning. Containing, 0.208 acres (9,063 square feet), more or less. Subject to all leLUl
highways, rights-of'-ways, casements, and reslrictions ofrccard,
SURVEYOR'S STATEMENT
To the best of my knowledge, information, and belief, this plat and legal description,
together with the Plat of Route Survey, recorded April 24, 2009 as instrument Number
2009023606 in the Office of the Recorder of I•Inmillon County, Indiana (incorporated and
made a part hereof by referericc), comprise a route survey executed in accordance with
Indiana Administrative Code 05 IAC 1 12 "Rule 12
RONALD L. NOLANr
DATE" August 25, 2009 Registered Lund Surveynr SO 439
Alt pt60iUlllllllrrytr� rrr0
SO 439
r bra,c v
n �j��•rN hart; t�
Page 1 of 2
Ya'rnjcci filcc aclivd1U7110ri Gtntr_I 111601 Suvcl ur win p11pn' +innUim,c rocn Ls110 Pi Iprim cM1AmnouLdoc
$.W. CORNER OF S,E. j Of S.E.
SECTION 5— T1.7N —R3E
(NO MONUMCNT FOUND, n
CALCULATED CORNER) EXHIBIT B
OWNER: PILGRIM LUTHERAN CHURCH OF INDIANAPOLIS INC.
DEED RECORD; INSTR. N0, 200200072725
HAMILTON COUNTY PARCEL N0, 32- 17- 13- 06- 04-05- 001,001)
x a
RIGHT OF WAY
6 2n
NEW
I
EXISTING DRAINAGE
EASEMENT 11 8729851
RIGHT —OF WAY PERMANENT EASEMENT
0.398 ACRES p
(17,322 SO, F E.
Li
V) z
�9
..t
,p�2, 6
Z
PERMANENT EASEMCNI'
0.208 ACRES.
(9,063 SO. FT.)±
t
40' WIDE EXISTING RIGHT—OF— WAY
INSTR. 8729851 20D300015157
,n
n
7 6 z
S.E. CORNER S.E. —O �o 100
g SECTION 6-- T17N -•R3E
f (RAILROAD SPIKE 1
�i FOUND PER HCSO REFS) 1 inch 100 M
r.:a,ner ,nnmr.m T �j cluArm7GiiMilo.
HA4C P. W R.LN. E I1r FBI IIC B
u hu SO f A PART OF THE S.E. 114 SEC. 6- *F17N -R3E
k 9i, =100`
5 PRF..PAREp FpRi- ,mxuca,o
PROJF,Cf IiI17J�ipi u. b:.:i:':u.� m.
w...�,:.n„ THE CITY OF CARMCL� INDIANA a 107006 ..,.n�,,,
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Label /Receipt Number: 7009 1410 0000 1956 1035
Status: Delivered Tra c k Corifitlia T
Your item was delivered at 1'59 pm on October 19, 2009 in Enter Label /Receipt Number.
INDIANAPOLIS, IN 46290 A proof of delivery record may be available
through your local Post Office for a fee
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Label /Receipt Number: 7009 1410 0000 1956 1028
Status: Delivered Trafk Confi €nI
Your item was delivered at 1:59 pm on October 19, 2009 in Enter Label/Receipt Number.
INDIANAPOLIS, IN 46290 A proof of delivery record may be available
through your local Post Office for a fee.��
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Label/Receipt Number: 7009 1410 0000 1956 1042
Status: Delivered re�i'k t�tl,rrn
Your item was delivered at 1:21 pm on October 19, 2009 in FISHERS, IN Enter Label /Receipt Number.
46038. A proof of delivery record may be available through your local
Post Office for a fee.Ek Y
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Project: 106"' Street :fron-, bitch Road
to Michigan Road
Parcel 9
WA.lU ANTV I)IsED
']'HIS INI)EN]URIA ATFNLSSETH THAT l9grim Lutheran Church of :Indianapolis, Inc.
"Glantor"), conveys and \Var mnN to the City of Carmel, Indiana (the Wantec"I for the sum of forty nkc
"thousand Dour 1- Iundred and 00/100 Dollars (.$49,400.00) and other valuable considaTtion, the receipt and
sufficiency of which is hereby ncknowledged, the following described real estate in Flamilton County, State of
Indiana:
See attached Exhibit A and EMAhk B, which are attached hereto and incorporated herein
subject to 0) the Lien for real estate taxes and assessments not yet clue and payable; (ii) any and all easements,
agreements, rest rietions and other miatters of record; and (iii) matters that would be disclosed by an accurate
survey or physical inspection of the real estate.
It is understood between the parties liureto, and their successors in title, and made a covenant herein which shall
run with the land, that ail real estate hcrein described (excepting; any pwvds or portions thereof l:hat are
1 l Y i J I and
spcci'licall} and expressl de as 'as �mc��ts or t:emporary rights o� sway) are conveyed in fee simh>>e
not merely for right of way purposes, and IhM no reveNonmy rights whatsoever are intended to remain in the
Grantor.
The undersigned person oxecut.in,, this decd represents and cer6fics on behalf of the Grantor that he /she is a
duly Acted officer of the Grantor and has been fully empowered and authorized by proper resolution, or by the
by -laws of the Grantor, to execute and deliver this deed; that to Grantor A 1 corporation in good standing, in the
State of InTana; that the Grantor has full corporate capacity to convey the real estate described; and that all
necessary corporate action Or the malting of this conveyance has been club, taken.
IN W1 T�NliSS_VI MF;TZIOP, Gra.7tor hay carOcd this WarraJ.ty 1)ced 'ta be execntecl this day of
20 1 0.
GRANT R:
Pilgrim Lutheran C:U& ofindianalWis, brio.
D an Montgomery, 1 'it
NOTARY CE;RI'11'ICAT,IQN
STATE OP INDIANA
Ss:
COUNTY CAF
Before me tho undo ►signed, a Notary Public in and l;Or said County arid, State, personally
appeared Dan Montgomery, 1'resicieA of Pdgdrn Lutheran Church of lndi napolis, Ine., who achno the
execution of the [oregoing Warranty Deed for and on behalf of such Lrantor, and who, leaving bCC11 duly swor11,
stared that the represe ntations therein contailled are true.
Wl'1'N'E'SS my hand and Tdottsrial meal da:,' c>;.,__ %"�f 2010.
`ly corn;Y,:: :Sion E`pires: x�l�__
Cot �y of
I T�`OtHry 1I��l.attlY'C
Notary .T'rinwd Nalue
"Phis instrument was prepared by Douglas C, I l mey, Anne] City AuDmey, City HOW One Civic Square, Carmel, Indiana
46032
Send tax bills to: One Civic Square, Carmel, IN 46032'
Altc-r recording, return dcud to: Douglas Q 1-laney, Anne] Chy Attorney, City Hall, One CNN Square, Carmen inC imul
4(032
I Afirn, under the penalties Or perjury, th'it I imve take ►1 reasonable care to redact cach and every Social Security
number from this documenk unless it is required by MY Douglas C. I_laacy
1/2427032.3
CI 11 No.
in t1w 01'1'1ce 01"'hu Re(ordc�j ("I'l hmlilk)n cowrlty. Indiana
K,N0\V ALL iMIA BY PRESENTS that the mdersignet PHgArn fAltheran
Church of Indianapous, inc. as the be owner of certain real estate (herchnahm wAlecth
referred to as "GmmoQ, for and K considnatimi of the sum of Ten and 00/100 DDUARS
($1 ROO) and other whmMe considerati i h paid, the receipt an d awh6c,,, o f hi,h i
hereby acknowledged and confessed, does hereby GRANT, BAIWAIN, SEE, AND CONVEY
UNITO TI City ofCallnel, Indiana, an Indiana muNcipi co its successors and assigns
(hereinafter referred to as "UmnWel, a non-exclusive and perpetual easement upon, over, unde
and across dic! real estate located in Hamilton County, Indiana, and described in Exhibit "A" and
f"AiNt "B" attached hereto and hemby nwde a part hereof, for the purpose of laying, IAMB,
constructing, maintahing, openAg, Mspeclinj aheriny Qvicing and removing utility hcs,
equipment and it multi use IXTI, Grantee shad be responsible fbr maintaining A such uWU
lines, 0CjUiPlWnL and pat in good order and repair at Grantees sole cost and expense.
Notwithstanding the 1:oj- (1- cast afmpairilIg any daI11,19C to the Utility lilICS, CClUij)1l Or
path caused by Grantor (ordinLiry v"cay and tear excepted), Is employees, ag?nts, contractors,
licensees, inviLecs or tenants shall he or"tmor's 1
Gwil(ce sl-all have the right of ingress and cgress over, under, q3on and merass any IaQ
driveways and roadways loc on the ,surface of the Ads owned by Grantor, its successors and
assigns, upon and wilim Q boundaries of the caselne area. Nor purposes of ancess to Q
easement area. Said easennew also includes the dghts and privjlegcs to t ell) p ol: jr j I y tjsC. f joln
15n C to W, HdditiO1111 sj)aCC, %A, avolawt UIKI reasonably necossary, that is adJacont t0 the
easomel "u for the Icniporary SIomge and swim or oqIpment End materials necessary It-
the installation, repair and naakonance of (howces lacilides loco cd I, wider, upon, over,
acid /ol' al:ross the casement circa and to do rill arts and Wings requisite and necCssary for the Cull
cnioyni(mt of the casement hereby granted; provided, Granice and its successors, agents, or
emphyccs shall promptly rcove the portion of the Grantor's property disturbed by their vmrl: is
a condition tllat. is as near the condition that existed ,just pi tor to tlre- time the portion was
distllrhed by them as is pracdcalle. Grantee aiso shall .Have the right from time to tilTle to remove
all trees, undergrowth, structures and /or other obstructions above, Within, under or ilnulediately
surro ndin ,P. the casement area which may unreasonably in�juvo, endanger or interfere with
i
C,rantee s use and enjoymrznt olthis cascn -lent, "-ill of' vvilich work shrill be clone at CY]"antce's sole
cost and expe:ase, ex";Cpt as otherwise suet fort'!] herein.
Grantor, its StlGCesSOrS of assigns, shrill not ercet or maintain any peraianent structures,
obstructions, or other iMprovements tinder and /or LIpor] the surlace of or over the easemer]t area
or perform any act ~which would impair' or interl'ere with Granice's use. and enjoyment of the
casement hack gmnted. The kni prcccding sentence prohibits (among the ot:he t
prohibitions CFRf ctcd by it) the eroWng or tt]a WAKing the casement mma of any earthen
mound or series or sy°rtua of crirthen mounds, NoWthstanding anything herehi to the contrary,
nothing in this Easement Agreemcnt shall prohibit or prevent. Granter and Grantor may, at any
We or from time to lime, subject to to conditions and romriotions herein, Construct, reconstruct,
install, maintain, rcp&r, and rCynce a ddvev; In, on, ovc!, thnwgh and a( toss the casement
area yroviciNg access to and from Grai]tor's Imupoi ly ani-i i 06th 5 #rcci. Any such dvive�vay
coustrnetion and related work shall bc; at Cfrtint.ol's sole e•..hpcnse, in accordance with till
ayphCable codes, Ord!rlances, laws W regulations arld shrill rogtUre Grantor to Obtain all
necessary approvds of the City of Carmel, its Plan Caturnklon and any other municipal body or
i'
I
entil:y en6ded to rCVle`W such construction or Mated ".vork,
Grantee shall provide, at (Ijantee's sod cost and expense (provided Grantcc
AM] not be reNmisibIc Gr fees or Gods incrurcd by Grantor in identifying the location ofthe tap
i
and valve anWor Grantee's comMorh thumW) and for the sole benefit of Grantor's property, a
i
six -inch (6") lap and valvc in the planned %vatelr line to be insIlled by Grantee or its successors
i,
or assigns through the easement nrc, i in approximately the location IdentECe%ll as "Approxlnlatc
l
'Mawr Tap Location' on Exh0ji "C"' attached hcrct.o. Grantor shall be responsible iGr all
I
1' availability, tap, connection, use and other fees associated with Grantor's connection to and use
of the water line.
If the surface of the casernent area is disturbcd by Grantee at any tinge, and/or [rom tin-,e
to time by the mstatlatlon, repFnr., nmintenance, removal, replacen or other work it?
connection with utility lines, cglprlent or the multi use path, Grantee, at its sole cost and
expense, shall repair and restore the surface, of the casenimt area and/or nearby property of the
Grantor to substantially th_e sansc condition whicil existed llllrnediately prior to an)F SUCK
disturbance, except to the extent that Gralttee was exercising its righi to remove items which, in
Granlcc's i-casonabk oph ion, is or would inwrf'erc %vith the rights granted herein. Any work
Im4b need or caused to be perfornhed upon, under and/or over or Whin the easennum aria tit any
We and hum We to trope shall be done at such a time and in such a manrher as will cause a
minimum of interlcrence with the business being c.or:dueled by Grantor (or its successcrs and
assigns) upon its Ad surrounding and adjoining the eLrsOnlcnh area, but nothing herein contained
shall prevent or prohibit Grantee, from perf'orming of its work durino normal and customary
daylight bLESr3hes3 110L1rs and HS necessary in tlhe event of cril l:nsC]'ge11Cy.
TO ti! \Vii AND TO I- I01_,D canto Cirai)(ec, its successors and assigns, so long, as the
3
i
rights and easements herein granted. shill be used bV C;rantee upoll the terms and conditions
specified herein, SO ingress to anti egress from the casement aretl, For Lhe purposes of
i
colaslrucl ng, ►nstalhng, rcpalring. malnta- lnlllg, re placing; and removing t Allides of Gramm
i
herein CICKI_ihCd but sLII JeW to a €1 Am cocul,lbrames. Wrictions and prior ease, umos
identified on Exhibit "lY alMchcd hereto nnci incorporated herein (collectively, the "Purnit(cd
lincumbrances
R is agreed UK this grant cov m all he agwernents boymen Ow parties and that no
representations or staterr.aents, verbal or written, have been made modifying. adding to or
Changing the tern of this agrcetnent.
The Grantor I-eprese;at:; and certifies that it is the fee simple owner of the easement arczl
subject to the Permuted Encunnbrariccs; that Grantor guarantees the quiet possession of the
easement area to the Grantee, sut jcet to the Permitted Encumbr« aces; that the, easement area is
Free of any liens or encumbrances, except the Permitted Encumbrances; and that, subject to the
foregoing, Granior wdl warrant and clefc'.iid Grantee's title to the easerncis granted hereby against
M1 ciailaas thercon,
T he psion or pmoons exegilting ?:h15 butriument on behalf of Granmor hereby represent
that they have the authority to bind t_irantoi toirat'y rn;ci individually, to the terms and conditiorls
set [orth herein.
rhis itasunment may ho ea:ecuied It GmWor in sepal'ate coumerpa m each of M;ich shall
constitute a dupiic�rte original.
(SJGNATUK -?S ON FOJA_,0W1N0 PAC I-31
4
IN TIES] IMONY
M 11LIVC CXLCLItC.d 'CII;18 COJ�VOy',IIICC ilS
Corporaholl, flli'� [1 (1,1y of' 2 G 10.
P11QF'JI1 I.Ald"ICY-111 ChUIVII Of1tld'a11LIp01,S I 1
4
13
llrcsi
NOTARY CFRTTICATION
STA"IT", 01
COUNTY OF
Belbrc me the umdersigncd, a'Kotary Public in and for said County and Statc, pc� �o 1 ly
r, i a[
app Dan i P'csicJ(;nt of Pilgrim Church of Indianapolis, 111C., who
ledged the OXCCL16011 01" 1.11C FOI-CgOilig Easement and on behalf of such Grantor, and
who, h.'wing becn duly sworn, sla that the ru r esenta l tigns 61croill contained are trlc'
3
WFFNI— my hand cu)d Notarial Se, :his' day of
!\."v Conimission E`, pIres:
Comatv ofResidence.
Nlotary Signaturc
Notary Printed ""'amc
^0unu�t"
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STATE 0FINDIANA
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C0DNTYOf
Bo[oro me the undo'vign»d a Y4ofury Pub]io in and Curouid County and SLutc, pcmouolly
nppourod of Thu City o[ cannel, ]odinno, all
lndiooa municipal ouq�nrahon n/ho ucknovv|udgcd ihccxuouhon or the foregoing Eoxoazouifor
and on hohu/FuCsuoh Grxn(a-, and, who, having been duly sworn, stalked that the /oprc sell totiouo
therein cmniaincd are true.
w|NESS nny hand and NoturisJ S*x\ fhiodxy of 2010.
MyConnniyxionExp|rom
County o[8uoidoncc:
NoixrySignuk/|o
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This iux'Rrumcui waxprcpxxcd by and oDcrrouurJingzc(urn to Douglas C, }fnncT Cuood City
Attorney, City T|uU. One Ovic 8quonq Cxnncl, NOW 4A0J2
u[flon. under rho, pcnu|box jb, ppijury, dho1 huno (ukcn rcusuoub|c curc iu rcduGicuvb uod
ovcry Sooia| SuoxriLy nnnnbc/' hnin this d000nionn un|uxu it is required by law DouA|ux C�
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PILGRIM I !THEE -kN C,- t-T
HHWEM WATER IAPLOCARIO
I A E E R S Yagc of Date.04,0 ?!2010
n
Mf1131 "F D
!�Grlll:ttCd Dic Ylbrance,
I bights ol'public in and to 1 06fl) StrcOt.
2. All liens e,nc�u���br�;nec s„ prior easements, res Hetions and other 1natteN onvcord.
3, All inattmi that would he disc and by an accurate survey or physical inspection of the real
Mal.
4. The hen Mr real estate taxes and assessments not ye: due and pa yable,
i_' Xhf 113.1 IT D I
1124 52609.4
Form Request for Taxpayer Give form to the
{Rev. October e Treasury Number and Certification requester. Do not
Department of th Treasury Send t0 the IRS.
Internal Revenue Service
Name (as shown on your income tax return)
Pilgrim Lutheran Church of Indianapolis, Inc.
Ili Business name, if different from above
a
c
o
o v limited liabilit co m p any. Enter proprietor Corporation Partnership
a e Check appropriate box: Ind Exempt
y p y. ter the tax classification (D= disregarded entity, C= corporation, P= partnership) payee
o Other (see instructions) 0-
Y
c Address (number, street, and apt. or suite no.) Requester's name and address (optional)
a o 10202 North Meridian Street
U City, state, and ZIP code
Indianapolis, IN 46290
w List account number(s) here (optional)
u)
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 is 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 chart on page 4 for guidelines on whose Employer identification number
number to enter. 35 6006636
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. I 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. I 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 nstructions on page 4.
Sign Signature of
Here U.S. person 01 4L)O GA 6-5, Date p► 2 (J 20 0
General Instructions D finition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted. e An individual who is a U.S. citizen or U.S. resident alien,
a A partnership, corporation, company, or association created or
Purpose of For 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) o 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 tax.
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. e The U.S. owner of a disregarded entity and not the entity,
Cat. No, 10231X Form W -9 (Rev. 10 -2007)
Prescribed by State Board of Accounts City Form No. 201 (Rev.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
A-6 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
Pilgrim Lutheran Church of Indianapolis, Inc.
Purchase Order No.
10202 N. Meridian Street
Terms
Indianapolis, IN 46290
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
n/a rn /a ROW Acquisition $66,200.00
approved by Council Resolution CC- 12- 21 -09 -03
please send check to Engineering Department for plu
by Crossroad Engineerg
r
Total
I hereby certify that the attached invoice(s), or bill(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.
ALLOWED 20
Pilgrim Lutheran Church of IndianapQ IN SUM OF
10202 N. Meridian Street
Indianapolis, IN 46290
$66,200.00
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
na
materials or services itemized thereon for
which charge is made were ordered and
received except
l2- 21 -0� -03
12 20
Signature
95� t -_mss lrtio c�
ost distribution ledger classification if Title
Jaim paid motor vehicle highway fund