174200 07/08/2009 CITY OF CARMEL INDIANA VENDOR: 363048 Page 1 of 1
ONE CIVIC SQUARE A G H PRODUCTIONS
CARMEL, INDIANA 46032 ARTHUR c HAAN a CHECK AMOUNT: $500.00
L 6006 SUNSET LANE
CHECK NUMBER: 174200
INDIANAPOLIS IN 4622e
CHECK DATE: 71$12009
DEPAR TMENT A PO N INV NUMB AM OUNT DES CRIPTION
902 4359003 500.00 JULY 12 JAZZ ON MONON
Ir
w
o m
I NVOI CE 6006 SUNSET LANE PHONE: 317 -590 -4663
INDPLS., IN 46228 EMAIL: AHAAN2 @COMCAST.NE
W W W,UPFDWNQUAR7E7.COM
BILL To:
CARMEL REDEVELOPMENT COMMISSION
30 WEST MAIN ST
STE 220
CARMEL, IN 46032
JULY 12 PERFORMANCE CARMEL ARTS DISTRICT JAZZ ON THE MONON $500 FEE
REMIT To:
AGH PRODUCTIONS
6006 SUNSET LANE
INDIANAPOLIS, IN 46228
d
Form 1111 ®9 Request for Taxpayer Give form to the
(Rev. October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name (as shown on your income tax return)
Arthur G. Haan II
0 Business name, if different from above
CL
o AGH Productions
w c Check appropriate box: Individual /Sole proprietor Corporation Partnership
o Exempt
a Limited liability company. Enter the tax classification (D =diaregarded entity, C =corporation, P= partnership)
payee
O Other (see inetructione)
,C C Address (number, street, and apt. or suite no.) Requester's name and address (optional)
a o 6006 Sunset Lane
v City, state, and ZIP code
to Indianapolis, Indiana 46228
a o List account number(s) here (optional)
to
JMI Taxpayer Identification Number IN
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 311 86 1536
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 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. 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, acq?rym.n tor abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generallte other tha n interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See th structions on page 4.
Sign Signature of
Here U.S. person Date 0. I
General Instructions Definition of a U.S. person. or federal tax purposes, you are
Section references are to the Internal Revenue Code unless considered a U.S. person if you are:
otherwise noted. An individual who is a U.S. citizen or U.S. resident alien,
0 A partnership, corporation, company, or association created or
Purpose of Form 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 Regulations section
transactions, mortgage interest you paid, acquisition or 301.7701 -7).
abandonment of secured property, cancellation of debt, or
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 from such business. Further, in certain cases where a Form W -9
requesting it (the requester) and, when applicable, to: 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
2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
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 The person who gives Form W -9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoidin withholdin
foreign partners' share of effectively connected income. g g
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)
eescribed bq State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
15. 229 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total SQ'J.QO
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.
2
ALLOWED 20
1
6, IN SUM OF
V CN C� SGG /f r L, G1dJ so
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3,596V3 SDo60 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
%S 20 0,9
Signature
Director of Operations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund