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Home My WebLink About177612 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363206 Page 1 of 1 ONE CIVIC SQUARE BLAIR CLARK CHECK AMOUNT: $500.00 CARMEL, INDIANA 46032 836 E AUMAN DRIVE CARMEL IN 46032 CHECK NUMBER: 177612 CHECK DATE: 9/29/2009 DEPARTMENT ACCOUN P O NUMBER I NVOICE NUMBER AMOUN DESCRIPTION 902 4359003 101 500.00 FESTIVAL /COMMUNITY EV Blair E Clark INVOICE 836 E Auman Dr Carmel In 46032 Phone 317 2018640 INVOICE #101 DATE: SEPTEMBER 3,2009 TO: FOR: Michael Lee Jazz on the Monon Intern 8/26/089 Carmel Arts and Design District Carmel In Email: mlee@carmel.in.gov Phone: (317) 571 -2796 Fax: (317) 571 -2789 Make all checks payable to Hfi1MVMdMdX3 b 1 Q1 e O 4 rk Payment is due within 30 days. If you have any questions concerning this invoice, contact Blair Clark 317 2018640 DESCRIPTION AMOUNT Band performance for jazz on the Monon $500.00 Artist: Blair Clark and Band members Performance Date 10/25/09 TOTAL $500.00 Form W4 (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 ni Name (as shown on your income tax return) rn Blair E Clark ra a Business name, if different from above C 0 0) N a o Individual/ corporation Partnership ther withholding from backup Check appropriate box: Sole proprietor p withholding c w Address (number, street, and apt. or suite no.) Requester's name and address (optiorra� 836 E Auman Dr L c City state, and ZIP code U CL Carmel Indiana 46032 U) CD List account numbef(s) here (optional) m Taxpayer Identification Number IN Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid 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. person Qncluding 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. (See the instructions on page 4.) Sign signature of Here U.S. person D� Date D C/ Purpose of Form o An individual who is a citizen or r ident 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 o 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 o The U.S. owner of a disregarded entity and not the entity, are: Cat. No. 10231X Form W -9 (Rev. 11 -2005) "Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properi itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, of hours, rate per hour, number of units, price per unit, etc. c Payee L ,1r L C IQr Purchase Order No. 8� l� E AtkMkh �r Terms 1�P 1 /ll J Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) n MUNN s S UM Total ST4b ,U I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same iriac6drdance with IC 5- 11- 10 -1.6. r 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 V \r E C lark IN SUM OF 836 E A(Ahkn Dr CQrt�e '460 ON ACCOUNT OF APPROPRIATION FOR 902/ L+359UU5, Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or %2 0 '435 5 00./0 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 Signat e Director of Operations Title p-u I I iutui venicie highway fund