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HomeMy WebLinkAbout163327 09/03/2008 CITY OF CARMEL, INDIANA VENDOR: 361772 Page 1 of 1 r f ONE CIVIC SQUARE NORTH AMERICAN MISSION BOARD CARMEL, INDIANA 46032 C/O TY SALTER CHECK AMOUNT: $30,000.00 4200 N POINT PARKWAY ALPHARETTO GA 30022 CHECK NUMBER: 163327 CHECK DATE: 9/3/2008 DfiPARTMENT ACCOU PO NUMBER INVOICE NUM BER AMOUNT DESCRIPTION 920 R4470202 30,000.00 106TH /KEYSTONE R -O -W II Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL INDIANA 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 North American Mission Board Purchase Order No. c/o Ty Salter Terms 4200 North Point Parkway Date Due AI haretto GA 30022 Invoice Invoice Description Date number (or note attached invoices) or bill(s)) Amount PROJECT: 07 -08: Ke stone Parkwa PARCEL: 23 COUNTY: Hamilton Compensation for Permanent (Fee Simple) Right -of -Way Total: $30,000.00 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 2008 Signature Title 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. 2008 Clerk- Treasurer VOUCHER NO. WARRANT NO. I ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION Board /Council Members FOR COST DISTRIBUTION LEDGER CLASSIFICATION IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND Acct. Account Title Amount No. Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL INDIANA 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 Carmel Church, SBC, Inc. Purchase Order No. 2240 E. 106" Street Terms Carmel, IN 46032 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount PROJECT: 07 -08: Keystone Parkwa PARCEL: 23 COUNTY: Hamilton ul o tion for rmanent Fee Simple Ri ht -of -Wa Total: 62 423.00 I hereby certi hat the ached invoice(s), or bill(s), is (are true and correct and that the materials or services itemized thereon for ich charge is made were ordered and r ei ed ex p 2008 By: nature I hereby certify that the attached invoice(s), or bill(s), is �e) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 2008 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION Board /Council Members FOR COST DISTRIBUTION LEDGER CLASSIFICATION IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND Acct. Account Title Amount No. AlsRav W a. Aupast I L 2WS (:7zr-a M. Hansen R%VS South. hic 5226 S. Elsi W Sum Indianapolis. IN 4622 (of5ce) 7.781.9727 (fa) \v-,vNv.-,N con-, PmPearty: Carmel Church. SBC, Inc. 2240 1: 106" St Carrel_ A 46032 Regarding PardA Release of Martgap Tne North." mcmcai Mission Board has woriked with tale church re° ardini_' this action and Partial Release of Mor Our agre-oment Avidi the church is thm trim thousand (S-10.000) be disbursed to thtNo-th :kmcrican Mission Board (IL-nder) and be appiicd to tht: principal �aiance %vhen received. The balanci of the distribution can be scm chrectly to the church. A you will find copies of thc. o,� cL=od Partial Release of Mor--.gajgt- Once lh-- North American Mission Board receives t payment. we will release ffie ori& documents to your anavion. Shouid you have any additional questions. pl-.ase do not li-.smaie.tcj call o- Thanks for yourassistance, Tv 56iter Team Coordimior. Church Financc Ministry 420C) North Poiri, Purkv. Alpharetta. CA 30022 800-759-590 Enclosure Page 4 PROJECT 07- 08 L Keystone Parkway PARCEL 23 i If you decide to accept the offer of 62.423.00 made by the City of Carmel, sign your name below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER F I (We), Carmel Church, SBC, Inc. i landowner(s) of the above described property or interest in property, hereby accept the !offer of $62,423.00 made by the City of Carmel on this day of 2008. i Carmel Chur I i By: By: (Sig e) (Signature) 14M-0A� (Printed Name) (Printed Name) By:. By: (Signature) (Signature) I (Printed Name) (Printed Name) NOTARY'S CERTIFICATE i STATE OF ':Z N 0 A N A SS: COUNTY OF M A 2 c o eJ i Subscribed and sworn to before me this a 9 day of 2008. My Commission Expires: 7 i My County of Residence is: (Signature) i cSP�NpA L AIM NA (Printed) NOTARY PUBLIC Form Request for Taxpayer Give form to the Department ent o o the e Trea sury (Rev. October Identification Number and Certification requester. Do not Internal Revenue Service send to the IRS. Name (as shown on your income tax return) Carmel Church, SBC, Inc. i CL Business name, if different from above 0 o CL e Check appropriate box: Individual/Sole proprietor Corporation El Partnership I Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership) Exempt `0 2 El Other (see insan chops) 0- Payee zi Address (number, street, and apt. or suite no.) Requester's name and address (optional) M.0 2240 E. 106th Street 0 City, state, and ZIP code w Carmel, IN 46032 N List account number(s) here (optional) Taxpayer Identification Number (TIN) I 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. O/ ;QS24�376�0 QQ Certification 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 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. citizen or other U.S. person (defined below). 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, acquisitio abando nt of secured property, c Ration of debt, contributions to an individual retirement arrangement (IRA), and generally, p nts of r interest and dividend y are not required to sign the Certification, but you must provide your correct TIN. See th n ructio o a e 4. Sign Signature of Here I U.S. person Date General V IO Definition of a U.S. person. F r Feder tax purposes, you are Section refer are to the ernal Revenue Code u ess considered a U.S. person if you are: otherwi� oted. An individual who is a U.S. citizen or U.S resident alien, A partnership, corporation, company, or a Purpose of Form association created or organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number (TIN) An estate (other than a foreign estate), or! to report, for example, income paid to you, real estate A domestic trust (as defined in Regulation's section transactions, mortgage interest you paid, acquisition or 301.7701 -7). abandonment of secured property, cancellation of debt, or j contributions you made to an IRA. Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: from such business. Further, in certain cases where a Form W -9 has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a!partner in a partnership conducting a trade or business in the United States, 2. Certify that you are not subject to backup withholding, or provide Form W -9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a income. U.S. person, your allocable share of any partnership income from who The person a U.S. trade or business is not subject to the withholding tax on p gives Form W -9 to the partnership for foreign partners' share of effectively connected income. purposes of establishing its U.S. status and i avoiding withholding on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases: substantially similar to this Form W -9. The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form W -9 (Rev. 10 -2007) Form W -9 (Rev. 10 -2007) Page 3 Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup Part I. Taxpayer Identification withholding for certain payments, such as interest and dividends. Number (TIN) Note. If you are exempt from backup withholding, you should Enter your TIN in the appropriate box. Ifjyou are a resident still complete this form to avoid possible erroneous backup alien and you do not have and are not eligible to get an SSN, withholding. your TIN is your IRS individual taxpayer identification number The following payees are exempt from backup withholding: (ITIN). Enter it in the social security number box. If you do not 1. An organization exempt from tax under section 501(a), any have an ITIN, see How to get a TIN below.1 IRA, or a custodial account under section 403(b)(7) if the account If you are a sole proprietor and you have an EIN, you may satisfies the requirements of section 401(f)(2), enter either your SSN or EIN. However, the IRS prefers that you use your SSN. 2. The United States or any of its agencies or instrumentalities, If you are a single- member LLC that is disregarded as an 3. A state, the District of Columbia, a possession of the United (LLC) on page e 2)� enter the owne s (or EIN i f the owner States, or any of their political subdivisions or instrumentalities, has one). Do not enter the disregarded entity's EIN. If the LLC is 4. A foreign government or any of its political subdivisions, classified as a corporation or partnership, enter the entity's EIN. agencies, or instrumentalities, or Note. See the chart on page 4 for further clarification of name 5. An international organization or any of its agencies or and TIN combinations. instrumentalities. How to get a TIN. If you do not have a TIN, apply for one Other payees that may be exempt from backup withholding immediately. To apply for an SSN, get Form SS -5, Application include: for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You 6. A corporation, may also get this form by calling 1- 800 772 -1213. Use Form 7. A foreign central bank of issue, W -7, Application for IRS Individual Taxpayer Identification 8. A dealer in securities or commodities required to register in Number, to apply for an ITIN, or Form SS -4, Application for the United States, the District of Columbia, or a possession of Employer Identification Number, to apply for an EIN. You can the United States, apply for an EIN online by accessing the IRS website at 9. A futures commission merchant registered with the www.irs.gov /businesses and clicking on Employer Identification Commodity Futures Trading Commission, Number (EIN) under Starting a Business. You can get Forms W -7 and SS -4 from the IRS by visiting www.irs.gov or by calling 10. A real estate investment trust, 1- 800 -TAX -FORM (1- 800 829 3676). 11. An entity registered at all times during the tax year under If you are asked to complete Form W -9 but do not have a TIN, the Investment Company Act of 1940, write "Applied For" in the space for the TIN, sign and date the 12. A common trust fund operated by a bank under section form, and give it to the requester. For interest and dividend 584(a), payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a 13. A financial institution, TIN and give it to the requester before you are subject to backup 14. A middleman known in the investment community as a withholding on payments. The 60 -day rule does not apply to nominee or custodian, or other types of payments. You will be subject to backup 15. A trust exempt from tax under section 664 or described in withholding on all such payments until you provide your TIN to section 4947. the requester. Note. Entering "Applied For" means that you have already The chart below shows types of payments that may be applied for a TIN or that you intend to apply for one soon. exempt from backup withholding. The chart applies to the Caution: A disregarded domestic entity that has a foreign owner exempt payees listed above, 1 through 15. must use the ap Form W -8. IF the payment is for THEN the payment is exempt part II. Certification for Interest and dividend payments All exempt payees except To establish to the withholding agent that you are a U.S. person, for 9 or resident alien, sign Form W -9. You may be requested to sign by the withholding agent even if items 1, 4, land 5 below indicate Broker transactions Exempt payees 1 through 13. otherwise. Also, a person registered under For a joint account, only the person whose TIN is shown in the Investment Advisers Act of Part I should sign (when required). Exempt payees, see Exempt 1940 who regularly acts as a Payee on page 2. broker Signature requirements. Complete the certification as indicated Barter exchange transactions Exempt payees 1 through 5 in 1 through 5 below. and patronage dividends 1. Interest, dividend, and barter exchange accounts Payments over $600 required Generally, exempt payees opened before 1984 and broker accounts; considered active to be reported and direct 1 through 72 during 1983. You must give your correct TIN, but you do not sales over $5,000' have to sign the certification. 2. Interest, dividend, broker, and barter exchange See Form 1099 -MISC, Miscellaneous Income, and its instructions. accounts opened after 1983 and broker accounts considered z However, the following payments made to a corporation (including gross inactive during 1983. You must sign the certification or backup proceeds paid to an attorney under section 6045(f), even if the attorney is a withholding will apply. If you are subject to backup withholding corporation) and reportable on Form 1099 -MISC are not exempt from and you are merely providing your correct TIN to the requester, backup withholding: medical and health care payments, attorneys' fees, and you must cross Out item 2 in the certification before signing the payments for services paid by a federal executive agency, form. REV -29 G %s, 8 iA`,.� H AuI R.. g Des NIA 07-05 1. This is a written statement of, and summary of the basis for, the establishment of the amount believed to be, through a valuation process, just compensation for the purchase of this right -of -way for highway purposes. The amount set forth in Item 5 below is not less than the approved estimate of value. Public Law 91 -646 provides that this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 2. The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Project 07 -08 Parcel 23 Road Keystone Parkway County Hamilton Owner(s) Carmel Church, SBC, Inc. 3. The area and type of interest being acquired: 0.648 acres of Fee Simple Acquisition The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part, except as may be explained in Item 8 below. 4. This acquisition is (Check one): a. A total acquisition of the real property. b. A partial acquisition of the real property. 5. The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: a. Total Land, Land Improvements and Buildings 61,654.00 b. Severance Damages (i.e.: Setback, Loss in Value to the Residues, etc) 0.00 c. Other Damages (Itemize) Cost- To-Cure estimates: Relocate signs 769.00 Temporary RIW 0.00 Total Damages 769.00 Total amount believed to be Just Compensation offered for this Acquisition is: 62,423.00 6. The amount in Item 5 above may include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and improvements are identified as follows: None 7. The amount in Item 5 above may include payment for the purchase of certain Land Improvements, Fixtures, Equipment, Machinery, Signs, Etc., and their ownership shall pass to the Acquiring Agency. These items are identified as follows: Lawn wooden pilla RR ties trees shrubs asphalt mulch bed and fencing A co to -cure is included to relocate two signs. 8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows: None 9. Remarks: The Fee Simple Acquisition includes 0.314 acres of Presently Existing Right -of -Way. 9�� Z ?jr�/JD0(1 I Signature Date Acquiring Agency: I 05 Code N/A I APPRAISAL REPORT Value Findings Short Form Long Form Partial Acquisition Total Acquisition Page 1 of 23 Type of Property Special Use (Church) Project# 07 -08 Indicate: (Residential, Commercial, Bareland, Farm, Special, Industrial) Location 2240 E. 106 Street, Carmel, IN 46032 Parcel 23 Owner Carmel Church, SBC, Inc., Phone (317)796 -8832 Road Keystone Parkway Address 2240 E. 106`" Street, Carmel, IN 46032 i County Hamilton Tenant Contract Buyer i Phone N /A i Address N/A I Land Areas: Before: 2.626 net Acs After: 2.292 net Acs Acquisition 0.648 Acs (including PER) F Temp. RAN N/A Perpetual RM N/A I ER 0.314 Acs Access Rights N/A CERTIFICATION OF APPRAISER I certify that, to the best of my knowledge and belief: I That I have made a personal observation of the property that is the subject of this report and that 1 have made a personal field inspection of the comparat sales relied upon in making said appraisal. The property being appraised and the comparable ales were as represented or referenced within the appraisal. That the statements of fact contained in the report are true and correct. That I understand that such appraisal MAY be used in connection with the acquisition of right -o -way for a project utilizing Federal funds. That such appraisal has been made in conformity with appropriate laws, regulations, policies and procedures applicable to the appraisal of property for sut purposes; and that to the best of my knowledge no portion of the value assigned to such pr perty consists of such items which are noncompensable and appropriate established law. That this appraisal assignment may have called for less than would otherwise be required by the specific guidelines of the ,Uniform Standards of Profession Appraisal Practices (USPAP), but is not so limited in scope tl) it may tend to mislead the user of the report, or the public. That I have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment. That my engagement in this assignment was not contingent upon developing or reporting predetermined results. That neither m employment norm com compensation for comp etin this assignment is contin t upon the development or reporting of a redetermined value Y Y P P 9 e 9 9� P P P 9 P i direction in value that favors the cause of the client, the am unt of the value opinion, the aft inment of a stipulated result, or the occurrence of a subseque event directly related to the intended use of this appraisal. That any decrease or increase in the fair market value of re 1 property prior to the, date of valuation caused by the public improvement for which said property acquired, or by the likelihood that the property would be a wred for such improvement, of er than that due to physical deterioration within the reasonat t. control of the owner, was disregarded in determining the con ipensation for the property. That the reported analyses, opinions, and conclusions are United only by the reported assuml tions and limiting conditions and are my personal, impartial, ai unbiased professional analyses, opinions, and conclusions. That I have no direct or indirect resent or prospective interest in the property that is the subject of this report and no personal interest with respect to tl P P P 1 P P P 4 parties involved; or in any benefit from the acquisition of suc property appraised. That the owner or a desi rated re resentafive was afforded the opportunity to accom an me on the property inspection. r I 9 P PP, o Y P Y P P Y P j That I have not revealed the findings and,results of such a praisal to anyone other than the iproper officials of the Acquiring Agency or officials of the Fede; Highway Administration and I will not do so until authorized y said officials or until I am required to do so by due process of law, or until I am released from tt obligation by having publicly testified as tosuch findings. That I have not given consideration, or included in my appra sal, any allowance for relocation assistance benefits.. Thpt no one provided significant real property appraisal assi tance to the person signing this report with the exception of those signing below. That my opinion of fair market value for the property to be ai quired and residue damages, if any, as of the 11th day t,• r of January. 2008 which is the effective date of this appraisal is 54.820.00 based upon my independent appraisal ud the exercise of my professional judgment. SUMMARY PRIMARY APPRAISE EF ORE VALUE 625,000.00 Signature W Z'VG� s: FTER VALUE 570,180.00 Named Typed Julie West I Appraisal License CG40400487 I and Taken r 48,580.00 Broker# IB20300226 I h.: Date: January 16 2008 and Improvements 5,440.00 ASSISTED BY mprovements t i �q, 000 !I Signature ost -to -Cure 800.00 Named Typed I i Appraisal License 1 amages to Residue 0.00 Broker i I Date: emporary RAN 0.00 r Signature :a I OTAL DUE OWNER t 54,820.00 Name Typed Appraisal License# i� I Broker I CF-3 Code #3782 'APPRAISAL REPORT Value Findings Short Form Long Form Partial Acquisition El Total Acquisition Page 1 'of 28 'Type of Property Church Project 07 -08 Indicate:(Residenbal, Commercial, Bareland, Farm, Special, Industrial) Location NWC of N. Keystone Avenue E. 106 Street Parcel 23 Owner Carmel Church, SBC, Inc. Phone (317) 818 -9191 Road NWC N. Keystone Ave. E. 106 St. Address 2240 E. 106 Street, Carmel, Indiana County Hamilton Tenant Contract Buyer Phone Address Land Areas: Before: 2.940 Gross Acres After: 2.292 Net Acres Acquisition 0.334 Acres 2.626 Net Acres Temp. RNV N/A Perpetual R/W WA PER 0.314 Access Rights N/A CERTIFICATION OF APPRAISER I 1 hereby certify: I That I have personalty observed of the property herein appraised and that I have personally made a field inspection of the comparable sales relied upon in making said appraisal. The property being appraised and the comparable sales were as represented or referenced within the appraisal. That t o the best of my knowledge and belief the statements contained in the appraisal herein set forth are true and the information upon which the opinions expressed herein are based is correct; subject to the limiting conditions set forth. That I understand that such appraisal MAY be used in connection with the acquisition of right-of-way for a project utilizing Federal funds. i That such appraisal has been made in conformity with appropriate laws, regulations, policies and procedures applicable to the appraisal of property for such purposes; and that to the best of my knowledge no portion of the value assigned to such property consists of such items which are noncompensable under appropriate established law. That this appraisal assignment may have called for less than would otherwise be required by the specific guidelines of the Uniform Standards of Professional Appraisal Practices (USPAP), but is not so limited in scope that it may tend to mislead the users of the report, or the public. That neither my employment nor my compensation for making this appraisal and report are in any way contingent upon the values reported herein. That an decease or increase in the fair market value of real p y p p rty prior to the date of valuation caused by the public improvement for which said property is acquired, or by the likelihood that the property would be acquired for such improvement, other than that due to physical deterioration within the reasonable control of the owner, was disregarded In determining the compensation for the property. That the reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions and are my personal, impartial, and unbiased professional analyses opinions, and conclusions. That I have no direct or indirect present or prospective interest in the property that is the subject of this report and no personal interest with respect to the parties involved or in any benefit from the acquisition of such property appraised. That I have no bias with respect to any property that is the subject of this report or to the parties involved with this assignment. That the owner or a designated representative was afforded the opportunity to accompany me on the property inspection. That I have not revealed the findings and results of such appraisal to anyone other than the proper officials of the Acquiring Agency or officials of the Federal Highway Administration and I will riot do so until authorized by said officials or until I am required to do so by due process of law, or until I am released from this obligation by having publicly testified as to such findings. That I have not given consideration, or included in my appraisal, any allowance for relocation assistance benefits. That no one provided significant real property appraisal assistance to the person signing this report with the exception of those signing below. That my opinion of fair market value for the property to be acquired and residue damages, if any, as of the 10th day of January 2008, which is the effective date of this appraisal is $70,026 based upon by Independent appraisal and the exercise of my professional judgment. SUMMARY PRIMARY APPRAISER BEFORE VALUE 619,000 Signature AFTER VALUE 548,974 Named Typed Erick Landee M Appraisal License CG40400483 Land Taken 63,481 Broker Date: January 15, 2008 Land Improvements 5,807 ASSISTED BY Improvements p Signature Cost -to -Cure 7 38 Named Typ James R. idreen j Appraisal License CG40600238 Damages to Residue 0 Broker Date: January 15, 2008 Temporary R/W 0 Signature TOTAL DUE OWNER 70,026 Name Typed Appraisal License Broker Form 25008 (Rev. 05) Date: lXBOLOGNA INC. Real Estate Counselors and Appraisers Page 1 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 North American Mission Board c/o Ty Salter Purchase Order No. NA 4200 North Point Parkway Terms Alpharetto GA 30022 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/27/08 NA 07 -08 Keystone Parkway 106th Street Just Compensation Land Cost Parcel 23 $30,000.00 Partial Mortgage Release Payment Please forward this check to Jeremy Kashman City of Carmel Engineers Office Total $30,000.00 I hereby certify that the attached invoice(s), or bills(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. L V 1 North American Mission Board c/o Ty Salter ALLOWED 20 4200 North Point Parkway IN THE SUM OF Alpharetto GA 30022 30,000.00 ON ACCOUNT OF APPROPRIATION FOR North American Mission Board c/o Ty Salter PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members DEPT.# NA NA 4470202 $30,000.00 1 hereby certify that the attched 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 August 29, 20 08 $30,000.00 Signature Cost distribution ledger classification if Cit En claim paid motor vehicle highway fund Title