191031 10/14/2010 „yF CITY OF CARMEL, INDIANA VENDOR: Page 'I of 1
4i ONE CIVIC SQUARE BRIAN GETS
0 CHECK AMOUNT: $250.00
CARMEL, INDIANA 46032 704 s BOOTS ST
MARION, IN 46953 CHECK NUMBER: 191031
CHECK DATE: 10/14/2010
DEP ACCOUN PO NUMBER INVOICE N UMBE R AMOUNT DESCRIPTION
851 5023990 250.00 BALLOONS
Brian's Balloons R NYORCE
704 S. Boots St.
Marion, IN 46953
Phone (219) 741 -0976
INVOICE
DATE: SEPTEMBER 15, 2010
TO: FOR:
Brian Getz Balloon entertainment at Safety Day
Brian's Balloons
704 S Boots St
Marion, IN 46953
(219) 741 -0976
DESCRIPTION AMOUNT
3 hours Balloon animals /entertainment at Carmel Public Safety pay $25p.DD
NdTE: Please make checkout to Brian Getz not Brian's Balloons
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0
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TO fAt $250.00
Make all checks payable to: Brian Getz
PaymerifJs due within 30 days.
If you haveiany questions concerning this invoice, contact Bria Getz, (219):711-0976
r
Thank you for your business!
Form W -9 (Rev. 11 -2005) Page 2
a The U.S. grantor or other owner of a grantor trust and not 3. The IRS tells the requester that you furnished an
the trust, and incorrect TIN,
a The U.S. trust (other than a grantor trust) and not the 4. The IRS tells you that you are subject to backup
beneficiaries of the trust, withholding because you did not report all your interest and
Foreign person. If you are a foreign person, do not use dividends on your tax return (for reportable interest and
Form-W-9. Instead, use the appropriate Form W -8 (see dividends only), or
Publication 515, Withholding of Tax on Nonresident Aliens 5. You do not certify to the requester that you are not
and Foreign Entities). subject to backup withholding under 4 above (for reportable
Nonresident alien who becomes a resident alien. interest and dividend accounts opened after 1983 only).
Generally, only a nonresident alien individual may use the Certain payees and payments are exempt from backup
terms of a tax treaty to reduce or eliminate U.S. tax on withholding. See the instructions below and the separate
certain types of income. However, most tax treaties contain a Instructions for the Requester of Form W -9.
provision known as a "saving clause." Exceptions specified Also see Special rules regarding partnerships on page 1.
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the recipient Penalties
has otherwise become a U.S. resident alien for tax purposes. Failure to furnish TIN. If you fail to furnish your correct TIN
If you are a U.S. resident alien who is relying on an to a requester, you are subject to a penalty of $50 for each
exception contained in the saving clause of a tax treaty to such failure unless your failure is due to reasonable cause
claim an exemption from U.S. tax on certain types of income, and not to willful neglect,
you must attach a statement to Form W -9 that specifies the Civil penalty for false information with respect to
following five items: withholding. If you make a false statement with no
1 The treaty country. Generally, this must be the same reasonable basis that results in no backup withholding, you
treaty under which you claimed exemption from tax as a are subject to a $500 penalty.
nonresident alien. Criminal penalty for falsifying information. Willfully
2. The treaty article addressing the income. falsifying certifications or affirmations may subject you to,
3. The article number (or location) in the tax treaty that criminal penalties including fines and /or imprisonment.
contains the saving clause and its exceptions. Misuse of TINsi If the requester discloses or uses TINs in
4. The type and amount of income that qualifies for the violation of federal law, the requester may be subject to civil
exemption from tax. and criminal penalties.
5.•Sufficient facts to justify the exemption from tax under. Specific Instructions
the terms of the treaty article.
Pxampie. Article 20 of the U.S. -China income tax treaty
Name
received b a Chinese studaX for scholarship income
allows an exemption from t
y ent. tern porarily present in the if you are an individual you must generally enter, the name
j shown.on your income tax return. However, States. Under U:S. law, this student will become a fynu have
a :resident alien for tax purposes if his or her stay in the United changed your last name, for instance, due to marriage
States exceeds 5 calendar years: However, paragraph 2 of without informing the Social Security Administration of the
the first Protocol to theU.S China treaty (dated April 30 social name cFiange, enter your #first name, the last name shovun on
I your soca security ,card an you me
1984) allows the provisions cf,Ahfc1e'20 to continue to apply tl r n last na
even after the Chinese student becomes a resident alien of" If the accounts i,n =joint names, list first; and them circle,
3 the United q he of the person or entity whose number you�'enterecl
exce tion (under s._ ara Chinese e h 2 of the first who qu alifies ss'
s name t he Part I of form..
p P 9 p p and i
relying this exception to claim an exemption from taxi on Sole proprietor Enter your: individuakname as shown on
his'or her scholarship or fell hip income would atfach to your income tax return on the "Na`me" line you, 'may enter
,Fo W -9 a statement that includes the information your business, tn ade Qr "doing business as IJ4' name on
described above °to supportahat 1 Athe "Business rern6`line.
L--�� lf'-you-are" a-nonresidbnt.Wieh-or a,foreign_entitY,'not sublect °._,_Limited liability con pany_(LLC):.lf_yau_ area single-member m
to backup withholding, -give- the requester the appropriate LLC (including a foreign LLC with a domestic owner) that is
coin e g 41orm ra e rom i s owner un er
What qs backup withholding? Persons making certain Treasury regulationssection 301.7701 -3, enter the owner's
ba
paymenfsto you must certain conditions withhold and namo
e n the "Name' line. Enter the LLC's name on the
pay to the'IRS 28% of such payments (after December 31_ r. Business name line ?;Check The appropriate box for your
2002) This is called backup wlthholdir g Payments that filing status (sole proprietor, corporation, etc.), then check
may be s backup withholding include interest, the box for "other "'and enter "LLC" in the space provided.
dividends, broker'and barter exchange transactions, rents, father entities. Enter your business name as shown on
royalties, nonemployee pay, and certain payments from required federal tax documents on the "Name line. This
fishing boat operators Real estate transactions are not,_ name should match. the name shown on the charter or other
1 �suedt�`to backup withholding a ;r legal document creating the entity. You may enter any
ou will not be subject to backup Y withholding on pay ents business, trade, or DBA name on the "Business name" line.
you receive if you give the requester your correct TIN, make Note You are requested fo check, the appropriate box for
the proper certifications, and report all your taxable interest your status (individual /sole proprietor, corporation, etc.).
and dividends on your tax return.
Payments you receive will be subject to backup Exempt Fr om backup W
withholding if: 3. If yauware exempt, enter your name as described above and
I1 You do not furnish your TIN to the requester, checkthe,'ap prop riate box for your status, then check�the
<2, Youstlo not certify your IT
en required (see the Part "Exernpt�ifirom backup withholding box•in4he'1ine. following,
V` Il instructions on page 4 for details), the business name, sign and,date1he form.
Form w -9 (Rev. 11 -2005) Page 3
Generally, individuals (including sole proprietors) are not part I. Taxpayer Identification
exempt from backup withholding. Corporations are exempt Number (TIN)
from backup withholding for certain payments, such as
interest and dividends. Enter your TIN in the appropriate box. If you are a resident
Note. If you are exempt from backup withholding, you alien and you do not have and are not eligible to get an SSN,
should still complete this form to avoid possible erroneous our TIN is your IRS Individual taxpayer identification number
backup withholding. (ITIN). Enter it in the social security number box. If you do
not have an ITIN, see How to get a TIN below.
Exempt payees. Backup withholding is not required on any If you are a sole proprietor and you have an EIN, you may
payments made to the following payees: enter either your SSN or EIN. However, the IRS prefers that
1. An organization exempt from tax under section 501(a), you use your SSN.
any IRA, or a custodial account under section 403(b)(7) if the
account satisfies the requirements of section 401 (f)(2), If you are a single -owner LLC that is disregarded as an
2. The United States or any of its agencies or entity separate from its owner (see Limited liability company
instrumentalities, (LLC) on page 2), enter your SSN (or EIN, if you have one). If
the LLC is a corporation, partnership, etc., enter the entity's
3. A state, the District of Columbia, a possession of the EIN.
United States, or any of their political subdivisions or Note. See the chart on page 4 for further clarification of
instrumentalities,
name and TIN combinations.
4. A foreign government or any of its political subdivisions, How to get a TIN. If you do not have a TIN, apply for one
agencies, or instrumentalities, or immediately. To apply for an SSN, get Form SS -5,
5. An international organization or any of its agencies or Application for a Social Security Card, from your local Social
instrumentalities. Security Administration office or get this form online at
Other payees that may be exempt from backup www.socialsecurity.'gov. You may also get this form by
withholding include: calling 1 -800- 772 -1213. Use Form W -7, Application for IRS
6. A corporation Individual Taxpayer Identification Number, to apply for an
7. A foreign central bank of issue, ITIN, or Form SS -4, Application for Employer Identification
8..A dealer in securities or commodities required to register Number, to apply for an EIN. You can apply for an EIN online
in the United States, "the District of Columbia, or a by accessing the IRS website at www.irs.gov /businesses and
possession of the United States, clicking on Employer ID Numbers under Related' Topics. You
9. A futures commission merchant registered with the can get Forms W -7 and SS -4 from the IRS by visiting
Commodity Futures Trading Commission, www.irs.gov or by calling 1- 800 -TAX -FORM
(1 -800- 829 3676).
10.'A real estate .investment,t rust, If you are asked to complete Form W -9 but do not have a
11. An entity registered at all,times during the tax year TIN; write "Applied For" in the space for the TIN,.sign and
under the investment Company Act of 1940, date the form, and give it to the requester. For interest and
12 A common frust.If d operated by"a bank under dividend payments, and certain payments made with respect'
sectian'584(a) to- readily tradable_ instruments, generally you will have 60
13' A financial institution,
days to get a T1N and give it to the requester before you are
subject to.backup withholding on payments. The 60 day rule
14. A' middleman known In the nvestmert community as a does not apply to other types of payments. You °vvill be
l nominee or, ustodlan or` subject to backup withholding on all such payments until you j
A trust exempt from tax under section 664 or provide,your TIN to the requester..'
described In section 4947: Note. Writing Applied For means that you have already i
a Iled for a TIN or that ou intend to a I foro'ne soon
The chart below shows ;types `of payments that may be pp Y t pp y
ersrnpt from backup withholding. The chart applies to,the Caution: A- disregarded domes tic entity that has a foreign
exempt reciplei listed" above :1 th r u h "'owner must use the appropriate Form W -8.
r
IF the for THEtJ the payment is exempt
for
Al
�Gi�A CP�9IIIU+
9 X I
E,xe Broker t4 sections mpt recipients 1 through 13
Also, a person registered under
the Investment Advisers Act of
1940 "who regularly acts as a
broker
Barter exchange transactions: Exe pt recipients 1 through 5
and pa rt onage dividends ;kl
.1
Payments over $600 required Generally, exempt recipients
P
to be reported and direct 1 through 7
�salas over $5,000
See Form 1999 -MiSC, Miscellaneous income and its instructions
'Hovveve the following payments made to a Corp ration (including gro,'ss
proceeds paid to an attorney "under sect on 60A5(f),'ewe if the attorney is a
f
`corporation) "and`'reportabI omForm 1099 -MI5C are not exempt from
backup withholding: medical and hea[R' are payments, attorneys' fees, and
payments for services paid by a federal executive agency.
Form W -9 (Rev. 11 -2005) Page 4
Part II. Certification What Name and Number To Give the
To establish to the withholding agent that you are a U,S. Requester
person, or resident alien, sign Form W -9. You may be
requested to sign by the withholding agent even if items 1, 4 For this type of account: Give name and SSN of:
and 5 below indicate otherwise. 1. Individual The individual
For a joint account, only the person whose TIN is shown in 2. Two or more individuals (joint The actual owner of the account
Part I should sign (when required). Exempt recipients, see account) or, if combined funds, the first
Exempt From Backup Withholding on page 2. individual on the account
Signature requirements. Complete the certification as 3. Custodian account of a minor The minor 2
indicated in 1 through 5 below. (Uniform Gift to Minors Act)
4. a. The usual revocable The grantor trustee
1. Interest, dividend, and barter exchange accounts savings trust (grantor is
opened before 1984 and broker accounts considered also trustee)
active during 1983. You must give your correct TIN, but you b. So- called trust account The actual owner'
do not have to sign the certification. that is not a legal or valid
2. Interest, dividend, broker, and barter exchange trust under state law
accounts opened after 1983 and broker accounts 5. Sole proprietorship or The owner 3
considered inactive during 1983. You must sign the single -owner LLC
certification or backup withholding will apply. If you are For this type of account: Give name and EIN of:
subject to backup withholding and you are merely providing 6. Sole proprietorship or The owner'
your correct TIN to the requester, you must cross out item 2 single -owner LLC
in the certification before signing the form. 7..A. valid trust, estate, or Legal entity 4
3. Real estate transactions. You must sign the pension trust
certification. You may cross out item 2 of the certification. S. Corporate or LLC electing The corporation
4. Other payments. You must give your correct TIN, but corporate status on Form
you do not have to sign the certification unless you have 8832
been notified that you have previously given an incorrect TIN. 9. Association, club, religious, The organization
.Other payments" Include payments charitable, educational, or made in the course of
the requester's trade or business for rents, royalties, goods other tax exempt organization
(other than bills for merchandise) medical and health care 10. Partnership or multi- member' The partnership 1.
services (including payments to corporations), payments to a LLC
nonempioyee for services, payments to certain fishing boat 11. A broker or. registered The broker or nominee
crew members and fishermen,, and gross proceeds paid to nominee
attorneys (including payments to corporations). 12. Account with the Department The public entity
5. Mortgage interest paid'by "you, acquisition or of Agriculture in the narrie,of
a public entity (such,as a
abandonment; of secured ro cancellation of debt,
p p state or local government,
qualified tuition program payments (under section.529), school district, or prison) that
IRA, Coverdefl; Archer MSA or HSA contributions or recelves;.agrjcultural program
d our l b lorre t TIN but you do not to sY� theust give payments
p
=.Y Y 9
Certification
Lis first and circle name of the erson whose nu
t€ h a to p m ber you furnish If
only one person on a joint account has an SSN; that persons number must': a
e 9 be furnished.
Circlethe minor's name and furrnsh e minor's SSN.
You must show your individual name'and u,may also enter your business,
i
f for DBA name on the second name line You ma ,use either your'SSN or
y
EIN "lif you have one). it you are a sole propnetbr IRS encourages you to
,use your SSN x
List first and circle the name of the legal trust, estate, or pension trust. (Do
f reyarding padnerships on-page 1.
,j Note:.lf noname is' circled when more than one name is
listed, thenumber will be considered to be that of the first.
name listed.
Privacy Act Notice
f
Section 6409 of the Internal Revenue Code requires you to provide your correctTIN to persons who must file information returns
with the IRS to report merest dividends'. and certain other Incom pand to you, mortgage interest you paid, the acquisition or
abandonment of secured property, cancellation of debt, or contributions you made, to an IRA,. or Archer MSA or NSA. The IRS
uses the numbers for identification purposes and to help verify the accuracy of your.tax return. The,IRS,may also provide this
=information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
posse,ssions.to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal
andstate agencies to enforce federal nontax criminal laws or to federal law enforcement and intelligence agencies to combat
terrorism f
�r You kst provide your T1N whether or riot you are required file. a tax return. Payees must generally withhold 28% ofrtaxable,
nterest; dividend, and certain other'payments to a payee =who `does not give a TIN to a payer. Certaln,penalties may also apply..
VOUCHER NO. WARRANT NO.
ALLOWED 20
Brian Getz
Brian Balloons I a IN SUM OF
704 S. Boots Street
Marion, IN 46953
$250.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!7f LE AMOUNT
Board Members
1120 $250.00 1 hereby certify that the attached invoice(s), or
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
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Firs; �Ctief
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'rescribed by State Board at Aocounla City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
�n invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
vhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$25000
i
hereby certify that`- the attached- tnvoice(s) ;6r bill(s), is- (ar`e) =true- and correct -and-T have audited- same- in- �aceordance
-JI voe� ®1�����90�i' rr cry
20
im r E C• 'i
Clerk- Treasurer
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