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Home My WebLink About186125 06/07/2010 CITY OF CARMEL, INDIANA VENDOR: 363206 Page 1 of 1 ONE CIVIC SQUARE BLAIR CLARK CHECK AMOUNT: $3,500.00 CARMEL, INDIANA 46032 PO BOX 4104 CARMEL IN 46082 CHECK NUMBER: 186125 CHECK DATE: 6/7/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4359003 325 3,500.00 ART OF WINE PERFORMER Blair Clark Invoice No. 325 836 E Auman Dr Carmel Indiana 46032 INVOICE Customer Misc Name Art Of Wine Carmel Redevelopment Commission Date May 18 2010 Address Order No. 00324 City Carmel State In ZIP Rep Phone 317 571 -2796 FOB Band Qty Description Unit Price TOTAL 1 Jazz Band For The Art of Wine Performance on 6 -19 -10 $3,500 3,500.00 SubTotal 3,500.00 Shipping Payment Check Tax Rate(s) Comments ATT Michael Lee TOTAL 3,500.00 Name CC Office Use Only Expires PA will be provided Thank you and God Bless o Form I R equest for Taxpay Give form to the (Rev. November 2005) Identification Number wind Certification requester. Do not Department of the Troasury send to the IRS. Infernal Ratvnue Service N Name (as shown an your income tax return) rn Blair E Clark 0 Q. Business name, if different from above c a m a o IndividuaV Exempt from backup .52 E] Corporation Partnership Other p TED D Check appropriate box: Sole proprietor withholding 02 c Address (number, street, and apt. or suite no.) Requester's name and address (optional) CL` 836 E Auman Dr U G City, state, and ZIP code U a Carmel Indiana 46032 ei m Ust account number(s) here (optional) n MI Taxpayer Identification Number N Enter your TIN in the appropriate box. The TIN provided must match the name given on Una 1 to avoid Social security alien, sale 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 idontfcation number 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. person (including a U.S. resident alien). Certification instructions. You must cross out item 2 above it 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 or f Z f� n Here U.S. person Date D. rC Purpose of Form J o An individual who is a citizen or r ident of the United A person who is required to file an information return with the States, IRS, must obtain your correct taxpayer identification number a A partnership, corporation, company,.or association (TIN) to report, for example; incorie paid to you, real estate created or organized in the United States or under the laws transactions, mortgage interest you paid, acquisition or of the United States, or abandonment of secured property, cancellation of debt, or o Any estate (other than a foreign estate) or trust. See contributions you made to an IRA. Regulations sections 301.7701 -6(a) and 7(a) for additional U.S. person. Use Form W -9 only if you are a U.S. person information. (including a resident alien), to provide your correct TIN to the Special rules for partnerships. Partnerships that conduct a person requesting it (the requester) and, when applicable, to: trade or business in the United States are generally required 1: Certify that the TIN you are giving is correct (or you are to pay a withholding tax on any foreign partners' share of waiting for a number to be issued), income from such business. Further, in certain cases where a 2. Certify that you are not subject to backup withholding, or Form W -9 has not been received, a partnership is required to 3 presume that a partner is a foreign person, and pay the Claim exemption from backup withholding if you area U.S. exempt payee. withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the In 3 above, if applicable, you are also certifying that as a United States, provide Form W -9 to the partnership to U.S. person, your allocable share of any partnership income establish your U.S. status and avoid withholding on your from a U.S. trade or business is not subject to the share of partnership income. withholding tax on foreign partners' share of effectively connected income. The person who gives Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding Note. If a requester gives you a form other than Form W -9 to withholding on its allocable share of net income from the request your TIN, you must use the requester's form if it is partnership conducting a trade or business in the United substantially similar to this Form W -9. States is in the following cases: For federal tax purposes, you are considered a person if you o The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231X Form fit/ -9 (Rev. 11 -2005) Prescribed by State 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 Q U I 1 r d k Purchase Order No. E. iA h1 X11 D C'. Terms C �I Yee. U /V 4 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) A rt of U M116 p prf orW ic X50 Q. o� Total 3 50 0, 0 0 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 'B)a'Ir Clark IN SUM OF Carmel, T At `+6032 3,500.00 ON ACCOUNT OF APPROPRIATION FOR Pay from Cash Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 12-5 T359 90 J 500,00 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 20/d Signature Director of Redevelopme Title Cost distribution ledger classification if claim paid motor vehicle highway fund