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Home My WebLink About175648 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 363206 Page 1 of 1 ONE CIVIC SQUARE BLAIR CLARK CHECK AMOUNT: $500.00 o CARMEL, INDIANA 46032 836 E ADMAN DRIVE CARMEL IN 46032 CHECK NUMBER: 175648 CHECK DATE: 816/2009 DEPARTMENT —..-----.,,,----ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4359003 100 500.00 FESTIVAL/COMMUNITY EV Blair E Clark EOICE 836 E Auman Dr Carmel In 46032 Phone 317 2018640 INVOICE #[100] DATE: JULY 21, 2009 TO: FOR: Carmel Redevelopment Commission Jazz on the Monon 30 W. Main St., Suite 220 7/26/089 Carmel, In 46032 Carmel In DESCRIPTION AMOUNT Band performance for jazz on the Monon $500.00 TOTAL $500.00 Make all checks payable to Blair E Clark Payment is due within 30 days. If you have any questions concerning this invoice, contact [Name, phone number, e-mail] Thank you for your business! Form W -9 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) 0 Blair E Clark m Q. Business name, if different from above C O N a c Individual/ Exempt from backup Check appropriate box: Sole proprietor El corporation El Partnership Partnership Other withholding r 2 Address (number, street, and apt. or suite no.) Requester's name and address (optional) c a 836 E Auman Dr v ?t City, state, and ZIP code 0 a Carmel Indiana 46032 rn N List account number(s) here (optional) Q) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 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 (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 retum. 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 �Z z Here U.S. person Date Purpose of Form An individual who is a tizen or r sident of the United A person who is required to file an information return with the States, IRS, must obtain your correct taxpayer identification number 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 presume that a partner is a foreign person, and pay the 3. Claim exemption from backup withholding if you are a 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) Prescribed by 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, rat! _Per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms x'32 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total SCE_ GY 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. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF SGY Ua ON ACCOUNT OF APPROPRIATION FOR l y� Board Members PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or go z kl)o 5 103 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 2009 Signature Qirector n_ Operations Title Cost distribution ledger classification if claim paid motor vehicle highway fund