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Home My WebLink About187662 07/20/2010 CITY OF CARMEL, INDIANA VENDOR: 364407 Page 1 of 1 I; 0 ONE CIVIC SQUARE CHRIS SHAFFER CHECK AMOUNT: $4,500.00 CARMEL, INDIANA 46032 2141 RINGGOLD AVENUE off INDIANAPOLIS IN 46203 CHECK NUMBER: 187662 CHECK DATE: 7/20/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4359003 7810 4,500.00 ROCK DISTRICT From: R V ®RCIE Chris Shaffer 2141 Ringgold Ave. Indianapolis, IN 46203 INVOICE 7810 DATE: JULY 12, 2010 To: FOR: Carmel Redevelopment Commission Rock the District concert 30 W. Main St., Suite 220 Carmel, In 46032 DESCRIPTION AMOUNT Headlining Rock the District on 7/24/10 $4,500.00 TOTAL $4,500.00 Make all checks payable to Chris Shaffer Thank you for your business! f C .r 1 Form W'9 Request for Taxpayer Give form to the (Rev. November 2005) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service N Name (as shown on y1 ur inco a tax return) f CL Business name, if different from above C O T N ndividual/ Corporation E] Partnership Other E] Exempt from backup Check appropriate box: Sole proprietor withholding O Address (number, street and ap %suite no.) J Requester's name and address (optional) a G C V 1 City, state, and ZIP c'de o. I /1 11 y List account numbers) here (opti #al) ar d 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 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. IMW Certificaticn 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 Intemal 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 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 Here U.S. person Date A 0 Purpose of Form An individual who is a citizen 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 A partnership, corporation, company, or association (TIN) to report, for example, income 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 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 The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231X Form W -9 (Rev. 11 -2005) 7rescribed by State Board of Accounts City Form No. 201 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 d fer Purchase Order No. R i h�n J Ave Terms is q (20 5 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7 9 /0 ee Q r 8 rd 5 0 .00 Total 500,00 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 C hr SA4f Pe IN SUM OF y q Rine old A ve IhJ ool is IN 4 6205 4,500,00 ON ACCOUNT OF APPROPRIATION FOR Pay from Cash 902,Z�35g003 Board Members PO# or INVOICE NO. DEPT. ACCT #!TITLE AMOUNT 4 I hereby certify that the attached invoice(s), or 7 910 159003 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 11— 2010 Signature Director of Redevelopment Title lion ledger classification if nor vehicle highway fund