187641 07/20/2010 CITY OF CARMEL, INDIANA VENDOR: 364402 Page 1 of 1
4 Qf� ONE CIVIC SQUARE JOE HITZFIELD CHECK AMOUNT: $280.00
CARMEL, INDIANA 46032 P O Box 71
PETERSBURG KY 41080 CHECK NUMBER: 187641
CHECK DATE: 7/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4359003 4 280.00 ROCK THE DISTRICT
From:
Joe Hitzfield ENVOICE
INVOICE #004
DATE: JULY 9,2010
TO: FOR:
Carmel Redevelopment Commission Entertainment Rock The District
30 W. Main St., Suite 220
Carmel, In 46032
DESCRIPTION AMOUNT
Entertainment Rock The District (Renegades) 280.00
TOTAL 280.00
Make all checks payable to Joe Hitzfield
Payment is due within 30 days.
If you have any questions concerning this invoice, contact [Name, phone number, e-mail]
Thank you for your business!
07/,19;'2010 08:52 FAX 513 542 8309 INTERSTATE TRAILER C¢jpOg
corm W Request for Taxpayer Give form to the
(Rev. NOvenj 7005)
oepaNmvm of rr&asu Identification Number and Certification requester, Do not
Irrtarnol RgVQnUb e. 5 eaaury Se nd to the IRS,
hi Nama (as shown on your intamp tea return)
Bw;incss name If different from above
9
0 dividual/ Exam t From hacku
U LJ CorpDra[[OtY Partnerr hi Qttter nn R P
L u Check appropriate box: Solo proprietor p LJ lixern ding
3
Add (Mg (number, street, and apt. or salt£ no.) Requeater'ti .,me anGl addross (optional)
1. .5 5
U
City, state, and 21P code
C.
v List account number( h6r0 (Optional)
m
W
Taxpayer Identification Number TIN
Enter your TIN in .no appropriate box. The TIN provided must match the name given on Line t to avoid
alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is
your employer identification number (EIN)- d you do not have a number, see How to got a 7YN on page 3. or
Note. If the account is In more than one' name, see the chart on page 4 for guidelines on whose nployer Ident1fleatlon number
number to enter.
Certification
Undor penalties of perjury, I certify that:
f. The number shown on this form is my correct taxpayer identification number (or I am waiting for a numb to be issued to me). and
2. 1 am net subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have t been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all lnteres m 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 -3. resident alien),
Certification Instructions, You must cross out item 2 above if you have been notified by the IRS that you al currently subject to backup
withholding because you have failed to report all Interest and dividends on your tax return. For real estate tr:. .iactione, item 2 does not aoply,
For mortgage Interest paid, acquisition or abandonment of Secured property, cancellation of debt, contributb: to an Individual retirement
arrangement (JRA), and generally, payments other than interest and dividends, you are not required to sign tP Certification, but you must
provide your correct TIN. (See the instructions o
page 4,)
Sign Sign taro Ot
Here US, parser 1► f Data
r
Purpose of Fo to file an infor tlori An individual who is a citi�l or resident of the u nited
A person who is requir return with the States,
IRS, must obtain your correct taxpayer identification number A partnership, corporation, smpany, or association
(TIN) to report, for example, income paid to you, real estate created or organized in the U :ted 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 Any estate (other than a foI gn estate) or trust. See
contributions you made to an IRA, Regulations sections 301.770 6(a) and �(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 partnershlll •i. Partnerships that conduct a
person requesting it (the requester) and, when applicable, to, trade or business in the Unity; States are generally required
1. Certify that the TIN you are giving is correct (or you are to pay a withholding tax on a ,r foreign partners' share of
waiting for a number to be issued), Income from such business, I' rther, in cerlaln cases where a
2. Certify that you are not subject to backup withholding or Form W 9 has not been reeei- .id, a partnership is required to
3. Claim exemption from backup withholding if you are a presume that a partner is a ft• :sign person, and pay the
U.S, exempt payee. withholding tax, Therefore, if ru are a U.S. person that is a
In 3 above, if applicable, you are also certifying that as a partner in a partnership coned voting a trade or business in the
arson, our allocable share of an United States, provide Form -9 to the partnership to
U.S.
p y y partnership income establish your U.S. status ant avoid withholding on your
from a U.S. trade or business is not subject to the share of partnership income.
withholding tax on foralgn partners' share of effectively
connected Income, The person who gives Forn N -9 to the partnership for
Note. If a requester gives you a form other than Form W -9 to purposes of establishing its t. status and avoiding
request your TIN, you must use the requester's form if it is withholding on its allocable sd re of net income from the
Substantially 5irriilar tb this Form W -9, partnership conducting a trac or business in the United
States is in the foliowing case
For federal tax purposes, you are considered a person The U.S. owner of a disregi fed entity and not the entity,
are
Cat. No. 10231X Form W -9 tAev. 11 -2005)
Prescribed,�y State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
J oe Purchase Order No.
6?yi
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
&rt of cover Land f I at P ack s i c 1 90,0 0
Total 8 Q Q p
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
J oe IN SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Pay from Cash
902 X359003
Board Members
PT INVOICE No. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
3Sq�03 2 gQ. 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
7 20
gnature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund