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Home My WebLink About197902 05/31/2011 CITY OF CARMEL, INDIANA VENDOR: 365312 Page 1 of 1 ONE CIVIC SQUARE LISA PICEK i'. CARMEL, INDIANA 46032 16121 DANDBORN GREEN CHECK AMOUNT: $276.96 WESTFIELD IN 46074 CHECK NUMBER: 197902 CHECK DATE: 5/31/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4340800 276.96 ADULT CONTRACTORS Form W 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 your income tax return) Lisa PE Q Business name, if different from above c 0 d N g p Individual/ Exempt from backup 2 ox:'"c' Check appropriate b Sole proprietor El Corporation Partnership Other withholding w Address (number, street, and apt, or suite no.) Requester's name and address (optional) a City, state, and ZIP code W1� r�1�f List account numbers) here (optional) to Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number 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. Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 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) k have not been notified by the Internal 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. (Se the Tructions on pa Sign Signature of y 1 f Here U.S. person I► Date I Purpose of Form o 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 o 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 e 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 withholding tax. Therefore, if you are a U.S. person that is a U.S. exempt payee. 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) TEAM GO 'T`RIATHLON MIYRiRG�1111 Bud r 4uk•,r INVOICE Purchaw 4 :4AM 1, 4 1 Date: May 3, 2011 Attention: Carmel Clay Parks and Recreation Motion Community Center r 0 g 34 b$ 0-0 Eric Mehl I U 1235 Central Park Drive East Carmel, IN 46032 �J Project title: Masters Swimming C Project description: April Masters Swimming Invoice P.O. Number: TMG005022011 a l Invoice Number: TMG005022011 H p Y �a p Terms: 30 Days If ��d p BYe 1?ESCRIPTION QUANTITY UNIT PItICE COST April Masters Participants 8 34.62 $276.96 0.00 0.00 0.00 0.00 0.00 0.00 0.00 S ubtotal $276.96 Tax .00% 0.00 T otal $276:96 The above invoice is for payment of the April Masters Swimming program. Price total includes the amount that Carmel Clay Parks and Recreation is contracted to receive. Sincerely yours, Lisa Picek 1612E Dandborn Green, Westfield, IN 46074 T201-705-2101 W www.resumatriathlon.com ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. Team Go Triathlon Terms 16121 Dandborn Green Westfield, IN 46074 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 5/3111 TMG005022011 Aril Masters swimming program 276.96 Total 276.96 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 Voucher No. Warrant No. Allowed 20 16121 Dandborn Green Westfield, IN 46074 1 In Sum of 276.96 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1096 -10 TMG005022011 4340800 276.96 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 19 -May 2011 Signature 276.96 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund