187645 07/20/2010 CITY OF CARMEL, INDIANA VENDOR: 364403 Page 1 of 1
ONE CIVIC SQUARE DAVE E AVENUE LEWIS CHECK AMOUNT: $280.00
CARMEL, INDIANA 46032
AURORA IN 47001 CHECK NUMBER: 187645
CHECK DATE: 7/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4359003 003 280.00 ROCK DISTRICT
From:
Dave Lewis �1!/
INVOICE #003
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 Dave Lewis
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!
0 x/19 ?2010 '08:52'FA� 513 542 8309 INTERSTATE TRAILER 4008
Form Win 9 bequest for Taxpayer Glve form to the
(Rev. November 2 requester. Do not
Identification Number and Certification
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Tax ayer Identification Number (TIN)
Entar your TIN in the appropriate box. The TIN provided must match the name given on tine 1 to avoid
alien, sole proprietor, or disregarded entity, see the Part I instructions on pag® 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 mere than one name, sea the chart on page 4 for guidelines on whose Iployar identilk -tion 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 for I am waiting for a numb to be issued to me), and
2. f am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have t been notifl d by the Internal
R®vanua Service (IRS) that I am subject to backup withholding as a result of a failure to report all Intereft .ir dividends, cr (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. 1 am a U.S. person (nciuding a U.S. resident alien).
Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you eil currently subject to backup
withholding because you have failed to report at interest and dividends on your tax return. For real estate tr; sections, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributir s to an individual retirement
arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign t1 Certification, but you must
provide your Oorrecf TIN. instructions on pag 4.)
Sign Signature of
Hers' U.S. person Iw r' 1 Date
Purpose of Form An individual who is a citiz, or resident of the United
A person who is required to file an information return with the States,
IRS, must obtain your correct taxpayer identification number e A partnership, corporation, ampany, or association
FIN) to report, far example, income paid to you, real estate Created or organized in the 1. 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 s Any estate (other than a fa gn estate) or trust See
contributions you made to an IRA. Regulations sections 301.771: •6(a) and TW 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 partnersh1l. Partnerships that conduct a
person requesting it (the requester) and, when applicable, to: trade or business in the Unite States are generally required
1. Certify that the TIN you are giving is correct (or you are to pay a withholding tax on a! foreign partners' share of
waiting for a number to be issued), income from such business. I rther, in certain cases where a
2, Certify that you are not subject to backup withholding, or Form W -9 has not been recer !id, a partnership is required to
3_ Claim exemption from backup withholding if you are a presume that a partner is a f( Sign person, and pay the
U.S. exempt payee. withholding tax_ Therefore, if .0 are a U.B. person that Is a
In 3 above, if a licable partner in a partnership cond sting a trade or business in the
PP you are also certi by g #hat as a United States, provide Form '•9 to the partnership to
U.S. person, your allocable share of any partnership income establish your U.S. status am 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 Fora N -9 to the partnership for
purposes of establishing its I, status and avoiding
Note. If a requester gives you a form other than Form W -9 to withholding on Its allocable s ,re of net Income from the
request your TIN, you must Use the requester's form if it is partnership conducting a tray_ or business in the United
substantially similar to this Form W -9. States is in the following case:
Far federal tax purposes, you are considered a person if you a The U.S, owner of a dl ded entity and not the entity,
are:
Cat. No. 10231X Form VII-$ (Rev, 11-1005)
Prescribed by 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
r�
D Av e- e wis Purchase Order No.
X Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
wi of cover d -F r Rack fhP D t�rr' 2-9
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
Doe Lewis
IN SUM OF
2$0.00
ON ACCOUNT OF APPROPRIATION FOR
Pay from Cash
902 g3S9003
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
A DEPT. 1 I hereby certify that the attached invoice(s), or
+3S 290-00 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
7-/2-20
Signature
Director of Redevelop
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund