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Home My WebLink About194640 02/16/2011 CITY OF CARMEL, INDIANA VENDOR: 00350077 Page 1 of 1 0 ONE CIVIC SQUARE INDIANA STREET COMMISSIONERS ASNiCK AMOUNT: $35.00 ,+o CARMEL, INDIANA 46032 CIO JOHN SCHNADENBERG w .oN Lp, 609 GRANT AVE CHECK NUMBER: 194640 CHESTERTONIN 46304 CHECK DATE: 2116/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4355300 35.00 ORGANIZATION MEMBER INVOICE INDIANA STREET COMMISSIONER'S ASSOCIATION 2011 I.S. C.A.. MEMBERSHIPS ARE .NOW DUE SEND DUES ($35.00) TO: John Schnadenberg Membership Director 609 Grant Avenue Chesterton, IN 46304 21.9- 926 -2222 2011 ISCA DUES $35.00 Only one S35. 00 fee required for membership per community. If your assistant or foreman needs a membership card, please note on your application form. APPLICATION FOR MEMBERSHIP CITY /TOWN: m NAME: LA V i Cl �I-� t n'l r E -MAIL ADDRESS: BUSINESS ADDRESS: I h� 1N LI L O BUSINES S PHONE: t6l 3 3 k00 FAX 9 66 1 DUES ENCLOSED: CLAIM FORM: RENEWAL: V NEW MEMBER: Call or send with this registration your suggestions for topics at this year's convention. i pr!!e W-9 Request for Taxpayer Give form to the tree laru:,ry zl Identification Number and Certification ren to t le I not treu,,r!r,�-a,i rr uia li,�;r;ru send to U IRS, N N;1!ne Indiana Street Commissioner's Association t ?,I I!less nowe, if diffcient from above 0 T.� 1nc4viduail (_xernpt from backup appropriate box: So 1) opiiator ccrpolaliorr partnetship Olhei As.s.QC wilhhoidiny o i Address numbei, street. and apt. or svnte no.) Requester's name and address (optior,aq C N 2` 1301 Lafayette Avenue LZ City, SIatC, 8nd ZIP code a Lebanon, IN 46052 ,n 1_i5i account numbc!(s) here (optional) W In Taxpayer Identification Number TIN Lriter yli Ur i fld II, li Jiu L`vx. vi in.)ld„ 7C,.:7, thi i•' ,'u: 5::; .y rp ,1.nliar (C GN1 il l I 1 I[ Social securrity numbLer f I I 1 ,:�;I fit i, i. i r f However, for a resident alien, sole proprietor, or disregarded entity, see the Part I Instructions o page 3. For other entities, it is your employer idenlificalton number ([IN). If you (lo not have a number, or see How to get a TIN on page 3 Note: if the account is in nror'e than orre name, see the chart cut p? igo 4 for grudelioes art ,chose rrurrrl)er Employer identification number to enter, Certification Under p of perjury, I certify that: 1. The nurnber shown on this form is my correct taxpayer idenlificauun Ilunlber (or I am yruting for a number to be issued to ale), and 2. 1 8111 not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have riot been notilled by the Internal Reve'nuu Service (IRS) that I am subject to backup withholding as it result of a failure In repuit all interest or dividends, or (e) the IRS has notified me that I aryl no longer subject to backup withholding, and 3. 1 am a U.S. person (including a U.S. resident alien), Certification instructions. You MUSL cross out !tern 2 above if you havo been notified by the IRS 0131. you are currently subjec[ to backctp withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, itern 2 does riot apply. For mortgage interest paid, acquisition or abandonment of secured propt�rty, cancellation of deb[, contributions to an individual retirement arrangement (IRA), and generally, payments ether than interest and dividends, you are riot requirod to sign the Certification, but you must provicle your conect TIN, (See the €nstruchonS on page 4.) Sign signature of Here U.S. person Late if Purpose of Form Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the A person who is required to file an information return with terms of a tax treaty to reduce or eliminate U.S. tax on the IRS, must obtain your correct taxpayer identification certain hypes of income. However, most tax treaties contain i number (TIN) to report, for example, Income paid to you, real provision known as a "saving clause." Exceptions specified estate transactions, mortgage interest you paid, acquisition in the saving clause may permit an exemption from tax to or abandonment of secured property, canceilation of debt, or continue for certain types of income even after the recipient contributions you made to an IRA. has whunwise become a U.S. resident alien for tax purposes. U.S. person, Use Form W -9 only if you are if U.S. person If you are a U.S. resident alien who is relying on an (including a resident alien), to provide your conect TIN to the exception conlained in the saving clause of a tax treaty to Berson requesting it (the requester) and, when applicable, to: claim an exemption from U.S. tax on certain types of income, 1. Certify that the TIN you are giving is correct (or you are you must attach a statement that specifies the following five yr aiting for a number to be issued), hunts: 2. Certify that you are not subject to backup withholdiny, 1. The treaty country. Generally, this must be the Sarno or treaty under which you claimed exemption from tax as a 1 Claim exemption from backuf) vvitftlwldinq if you are a nonresident alien. U.S. exempt payee. 2. The treaty article ad(iressing the income. Note: !f a requester Jives you a forrp other tl; m Form W -g 3. The article nurnber (or location) in the tax treaty that to request your TiN, you must use the requester' frlrnr if R is contains the saving clause and its exceptions. substantially similar to this Form W -9. 4. The type and arrnount of income that qualifies for the Foreign person. If you are 1.l foreign person, u the exemption frorn tax. appropriate Fonn W -8 (see Pub. 515, Wilhholdiny of T;rx on 5. Stlfficieni facts tc)justify the exemption from tax under Nonresident Aliens and Foreign Entities). the terms of the treaty article. Cal. NO 10231X Fnnn W -9 (Rev. 1 -20031 VOUCHER NO. WARRANT NO. ALLOWED 20 I.S.C.A. Membership IN SUM OF 609 Grant Avenue Chesterton, IN 46304 $35.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 43- 553.00 $35.00 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 Monday,/February 14, 2011 �V� Street Commissioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/04/11 $35.00 1 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