HomeMy WebLinkAbout177158 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 363330 Page 1 of 1
ONE CIVIC. SQUARE CHRISTOPHER AND TARA COVEY CHECK AMOUNT: $3,962.00
CARMEL, INDIANA 46032 16 LANDSDOWNE LANE
CARMEL IN 46033 CHECK NUMBER: 177158
CHECK DATE: 9/1512009
D EPARTME NT ACCOU PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
920 4470502 3,962.00 131TH /KEYSTONE R -O -W
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
Christopher L. Covey Purchase Order No.
Tara L. Covey Terms
16 Lansdowne Lane Date Due
Carmel IN 46033
Invoice Invoice Description
Date number (or note attached invoice(s) or bill(s)) Amount
PROJECT: 07 -08: Keystone Parkway 131st Street
PARCEL: 81
COUNTY: Hamilton
Appraised Value: $2,675.00
Administrative Settlement: $1
Compensation for Temporary Right -of -Way Total: 53,962.00
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
August 18 1 2009
(Signature) Christopheree Covey
ignature) Tara L. Cove
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.
2009
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.
Form W-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)
a Christopher L. Covey
co Business name, if different from above
a
C
D
N
W o Check appropriate box: Individual /Sole proprietor Corporation Partnership
Exempt
r P Limited liability company. Enter the tax classification (D= disregarded entity, C- corporation, P= partnership) p
Payee
a 2 Other (see instructions) 11-
c Address (number, street, and apt. or suite no.) Requester's name and address (optional)
CL e 16 Lansdowne Lane
0 City, state, and ZIP code
rn Carmel, IN 46033
List account number(s) here (optional)
U
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
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 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, 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 1 Date 0 I b
General Instructions Definition of 'a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted. O An individual who is a U.S. citizen or U.S. resident alien,
9 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 Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA. 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 avoiding withholding
foreign partners' share of effectively connected income. 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 2
The U.S. grantor or other owner of a grantor trust and not the 4. The IRS tells you that you are subject to backup
trust, and withholding because you did not report all your interest and
o The U.S. trust (other than a grantor trust) and not the dividends on your tax return (for reportable interest and
beneficiaries of the trust. dividends only), or
Foreign person. If you are a foreign person, do not use Form 5. You do not certify to the requester that you are not subject
W -9. Instead, use the appropriate Form W -8 (see Publication to backup withholding under 4 above (for reportable interest and
515, Withholding of Tax on Nonresident Aliens and Foreign dividend accounts opened after 1983 only).
Entities). Certain payees and payments are exempt from backup
Nonresident alien who becomes a resident alien. Generally, withholding. See the instructions below and the separate
only a nonresident alien individual may use the terms of a tax Instructions for the Requester of Form W -9,
treaty to reduce or eliminate U.S. tax on certain types of income. Also see Special rules for partnerships on page 1.
However, most tax treaties contain a provision known as a Penalties
"saving clause." Exceptions specified in the saving clause may
permit an exemption from tax to continue for certain types of Failure to furnish TIN. If you fail to furnish your correct TIN to a
income even after the payee has otherwise become a U.S. requester, you are subject to a penalty of $50 for each such
resident alien for tax purposes. failure unless your failure is due to reasonable cause and not to
If you are a U.S. resident alien who is relying on an exception willful neglect,
contained in the saving clause of a tax treaty to claim an Civil penalty for false information with respect to
exemption from U.S. tax on certain types of income, you must withholding. If you make a false statement with no reasonable
attach a statement to Form W -9 that specifies the following five basis that results in no backup withholding, you are subject to a
items: $500 penalty.
1. The treaty country. Generally, this must be the same treaty Criminal penalty for falsifying information. Willfully falsifying
under which you claimed exemption from tax as a nonresident certifications or affirmations may subject you to criminal
alien.
penalties including fines and /or imprisonment.
2. The treaty article addressing the income. Misuse of TINs. If the requester discloses or uses TINS in
3. The article number (or location) in the tax treaty that violation of federal law, the requester may be subject to civil and
contains the saving clause and its exceptions. criminal penalties.
4. The type and amount of income that qualifies for the
exemption from tax. Specific Instructions
5. Sufficient facts to justify the exemption from tax under the Name
terms of the treaty article.
Example. Article 20 of the U.S. -China income tax treaty allows If you are an individual, you must generally enter the name
an exemption from tax for scholarship income received by a shown on your income tax return. However, if you have changed
Chinese student temporarily present in the United States. Under your last name, for instance, due to marriage without informing
U.S. law, this student will become a resident alien for tax the Social Security Administration of the name change, enter
purposes if his or her stay in the United States exceeds 5 your first name, the last name shown on your social security
calendar years. However, paragraph 2 of the first Protocol to the card, and your new last name.
U.S. -China treaty (dated April 30, 1984) allows the provisions of If the account is in joint names, list first, and then circle, the
Article 20 to continue to apply even after the Chinese student name of the person or entity whose number you entered in Part I
becomes a resident alien of the United States. A Chinese of the form,
student who qualifies for this exception (under paragraph 2 of Sole proprietor. Enter your individual name as shown on your
the first protocol) and is relying on this exception to claim an income tax return on the "Name" line. You may enter your
exemption from tax on his or her scholarship or fellowship business, trade, or "doing business as (DBA)" name on the
income would attach to Form W -9 a statement that includes the "Business name" line.
information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to Limited liability company (LLC). Check the "Limited liability
backup withholding, give the requester the appropriate companyt D
box only and enter the appropriate code for the tax
completed Form W -8. classification for disregarded entity, "C" for corporation, "P"
for partnership) in the space provided.
What is backup withholding? Persons making certain payments For a single member LLC (including a foreign LLC with a
to you must under certain conditions withhold and pay to the domestic owner) that is disregarded as an entity separate from
IRS 28 of such payments. This is called "backup withholding." its owner under Regulations section 301,7701 -3, enter the
Payments that may be subject to backup withholding include owner's name on the "Name" line. Enter the LLC's name on the
interest, tax exempt interest, dividends, broker and barter "Business name" line.
exchange transactions, rents, royalties, nonemployee pay, and For an LLC classified as a artnershi or a corporation, certain payments from fishing boat operators. Real estate p p oration, enter p
transactions are not subject to backup withholding. the LLC's name on the "Name" line and any business, trade, or
You will not be subject to backup withholding on payments DBA name on the "Business name" fine.
you receive if you give the requester your correct TIN, make the Other entities. Enter your business name as shown on required
proper certifications, and report all your taxable interest and federal tax documents on the "Name" line. This name should
dividends on your tax return. match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBA
Payments you receive will be subject to backup name on the "Business name" line.
withholding if: Note. You are requested to check the appropriate box for your
1. You do not furnish your TIN to the requester, status (individual /sole proprietor, corporation, etc.).
2. You do not certify your TIN when required (see the Part II Exempt Payee
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect If you are exempt from backup withholding, enter your name as
TIN, described above and check the appropriate box for your status,
then check the "Exempt payee" box in the line following the
business name, sign and date the form.
Form W -9 (Rev. 10 -2007) Page 3
Generally, individuals (including sole proprietors) are not exempt Part I. Taxpayer Identification
from backup withholding. Corporations are exempt from backup Number (TIN)
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should Enter your TIN in the appropriate box. If you 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
have an ITIN, see How to get a TIN below.
1. An organization exempt from tax under section 501(a), any If you are a sole proprietor and you have an EIN, you may
IRA, a custodial account under section 403(b)(7) if the account enter either your SSN or EIN. However, the IRS prefers that you
satisfies the requirements of section 401(f)(2), use your SSN.
2. The United States or any of its agencies or If you are a single- member LLC that is disregarded as an
instrumentalities, entity separate from its owner (see Limited liability company
3. A state, the District of Columbia, a possession of the United (LLC) on page 2), enter the owner's SSN (or EIN, if 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
www.irs.gov /businesses and clicking on Employer Identification
9. A futures commission merchant registered with the Number (EIN) under Starting a Business. You can get Forms W -7
Commodity Futures Trading Commission, 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
A common trust fund operated by a bank under section form, and give it to the requester. For interest and dividend
12.
5812. 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
withholding on all such payments until you provide your TIN to
15. A trust exempt from tax under section 664 or described in the requester.
section 4947. 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 appropriate Form W -8.
IF the payment is for THEN the payment is exempt part II. Certification
for...
To establish to the withholding agent that you are a U.S. person,
Interest and dividend payments All exempt payees except or resident alien, sign Form W -9. You may be requested to sign
for 9 by the withholding agent even if items 1, 4, and 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
during 1983. You must give your correct TIN, but you do not
to be reported and direct 1 through 7 have to sign the certification.
sales over $5,000'
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 inactive during 1983. You must sign the certification or backup
However, the following payments made to a corporation (including gross withholdin will a If you are subject to backup withholding
proceeds paid to an attorney under section 6045(f), even if the attorney is a g PP y' y I p g
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.
Form W -9 (Rev. 10 -2007) Page 4
3. Real estate transactions. You must Sign the certification. Secure Your Tax Records from Identity Theft
You may cross out item 2 of the certification.
Identity theft occurs when someone uses your personal
4. Other payments. You must give your correct TIN, but you information such as your name, social security number (SSN), or
do not have to sign the certification unless you have been other identifying information, without your permission, to commit
notified that you have previously given an incorrect TIN. "Other fraud or other crimes. An identity thief may use your SSN to get
payments" include payments made in the course of the a job or may file a tax return using your SSN to receive a refund.
requester's trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services To reduce your risk:
(including payments to corporations), payments to a Protect your SSN,
nonemployee for services, payments to certain fishing boat crew Ensure your employer is protecting your SSN, and
members and fishermen, and gross proceeds paid to attorneys Be careful when choosing a tax preparer.
(including payments to corporations).
Call the IRS at 1 -800- 829 -1040 if you think your identity has
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt, been used inappropriately for tax purposes.
qualified tuition program payments (under section 529), IRA, Victims of identity theft who are experiencing economic harm
Coverdell ESA, Archer MSA or HSA contributions or or a system problem, or are seeking help in resolving tax
distributions, and pension distributions. You must give your problems that have not been resolved through normal channels,
correct TIN, but you do not have to sign the certification. may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll -free case intake line
What Name and Number To Give the Requester at 1 -877- 777 -4778 or TTY/TDD 1- 800 -829 -4059.
Protect yourself from suspicious emails or phishing
For this type of account: Give name and SSN of: schemes. Phishing is the creation and use of email and
1. Individual The individual websites designed to mimic legitimate business emails and
2. Two or more individuals Joint The actual owner of the account or, websites. The most common act is sending an email to a user
account) if combined funds, the first falsely claiming to be an established legitimate enterprise in an
Individual on the account' attempt to scam the user into surrendering private information
3. Custodian account of a minor The minor that will be used for identity theft.
(Uniform Gift to Minors Act) The IRS does not initiate contacts with taxpayers via emails.
4. a. The usual revocable savings The grantor trustee' Also, the IRS does not request personal detailed information
trust (grantor is also trustee) through email or ask taxpayers for the PIN numbers, passwords,
b. So- called trust account that is The actual owner' or similar secret access information for their credit card, bank, or
not a legal or valid trust under other financial accounts.
state law
5. Sole proprietorship or disregarded The owner' If you receive an unsolicited email claiming to be from the IRS,
entity owned by an individual forward this message to phishing @irs.gov. You may also report
For this type of account: Give name and EfN of: misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
6. Disregarded entity not owned by an The owner 1 -800- 366 -4484. You can forward suspicious emails to the
individual Federal Trade Commission at: seam @uce.gov or contact them at
7. A valid trust, estate, or pension trust Legal entity www.consumer.gov /idthelt or 1- 877- IDTHEFT(438- 4338).
8. Corporate or LLC electing The corporation
corporate status on Form 8832 Visit the IRS website at www,irs.gov to learn more about
9. Association, club, religious, The organization identity theft and how to reduce your risk.
charitable, educational, or other
tax- exempt organization
10. Partnership or multi- member LLC The partnership
11. A broker or registered nominee The broker or nominee
12. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
List first and circle the name of the person whose number you furnish. If only one person
on a joint account has an SSN, that person's number must be furnished.
Circle the minor's name and furnish the minor's SSN.
0
You must show your individual name and you may also enter your business or "DBA"
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Also see Special ales for partnerships on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to titles, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this Information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.
MEMORANDUM
TO: City of Carmel
FROM: Nancy E. Hermann, Acquisition Agent
RWS South, Inc.
5214 South East Street, Suite D -2
Indianapolis, IN 46227
DATE: August 12 2009
RE: Project: 07 -08: Keystone Parkway 131" Street
Code: _N
Parcel: 81
County: Hamilton
Owner(s): Christopher L. Covey
Tara L. Covey
SUBJECT: Recommendation for Administrative Settlement
The City's fair market value determination of 2,675.00 for 492 square feet of temporary right -of -way, land
improvements, and cost -to -cure was offered to the owner(s). During the negotiation process, the property
owner(s) rejected this offer stating that they should have an additional 1,287.00
The owner obtained estimates for fence relocation and trees at a value higher than what was included in the
City's appraisal.
We believe it is in the best interest of the City to settle this parcel for 3,962.00 This is an increase of
1,287.00 over the appraised amount, and we believe a great deal of time and money can be saved by
settling this parcel as opposed to acquiring it through condemnation.
Therefore, the City's acquisition agent is directed to offer 3,962.00 to the owner(s). Should they not
accept, then the additional 1,287.00 will be withdrawn and the 2,675.00 figure will remain the approved
amount.
THIS RECOMMENDATION APPROVED:
1AE.
Page 4 PROJECT 07 -08: Keystone Parkway 131S St. PARCEL 81
If you decide to accept the offer of 2,675.00 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
I (We), Christopher L. Covey and Tara L. Covey, husband and wife
landowner(s) of the above described property or interest in property, hereby accept the offer of
$2,675.00 made by the City of Carmel on this 18 day of August 2009.
Appraised Value: $2,675.00
Administrative Settlement: $1,287.00
Total: $3,962.00
CA ov'& d� (1, YAA—
(Signature) (Signature)
Christopher L. Covey, husband Tara L. Covey, wife
(Printed Name) (Printed Name)
NOTARY'S CERTIFICATE
STATE OF Indiana
SS:
COUNTY OF Hamilton
Subscribed and sworn to before me this 18th day of August 2009.
My Commission Expires: August 4, 2016
My County of Residence is: Marion
(Sig atu t
NWYHERMANN
Marion Camry
My Commission Expires Nancy E. Hermann Augusta,2ois (Printed) NOTARY PUBLIC
10/08 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code N/A
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 road construction purposes. The amount set forth in Item 5 below is
not less than the approved estimate of value. In accordance with Public Law 91 -646 as amended, the "Uniform Act and as codified in
Indiana at IC 8- 23 -17 -1 through 8- 23- 17 -35, 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 81 Road Keystone Pkwy County Hamilton
Owner(s) Christopher L. Tara L. Covey
3. The area and type of interest being acquired: 492 SF of Temporary Right -of -Way
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 pairt, except as may be explained in Item 8 below.
4. This acquisition is (Check one): a. U A total acquisition of the real property.
b. El A partial acquisition of the real property.
5. The Agency's Offer: Just compensation has bee 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 300.00
b. Severance Damages (i.e.: Setback, Loss in
Value to the Residues, etc)
c. Other Damages (Itemize)
Cost -To -Cure estimates:
Relocate Wood Privacy Fence 1,800.00
Temporary Easement 575.00
Total Damages 2,375.00
d. Drainage Easement 0.00
Total amount believed to be Just Compensation offered for this Acquisition is: $2,675.00
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:
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:
One small deciduous tree and one medium deciduous tree.
8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows:
9. Remarks:
Signature: Signature:
Name Printed-- Name Printed:
Title: j Company:
Date: Date:
4/08
Code N/A
kType of Property Residential Im roved Project: 07 -08
Indicate: Residential, Commercial, Bareland, Farm, Special, Industrial
PL6 catlon� 16 Lansdowne Lane, Carmel, IN 46033 Parcel 81
f�i e� »�3 r Owner Christopher L. Tara L. Covey Phone 765 729 -0308 (cell) Road Keystone Parkway
I; Address 16 Lansdowne Lane, Carmel, IN 46033 County Hamilton
Area and type of Acquisition: F66 Sirri RM N/A
Acc N/A
tlt Ternpora f ryRNV 492 SF
�'�T�YPE�OF' REP ,OR,T'AND4,VALlJATION�FORMAT
Section 24.102(c) (2) Appraisal, waiver thereof. The purpose of the appraisal waiver provision is to provide Agencies a technique to avoid the costs and
time delay associated with appraisal requirements for low- value, non complex acquisitions. The intent is that non appraisers make the waiver valuations,
freeing appraisers to do more sophisticated work. The Agency employee making the determination to use the appraisal waiver process must have enough
understanding of appraisal principles to be able to determine whether or not the proposed acquisition is low value and uncomplicated. Waiver valuations
are not appraisals as defined by the Uniform Act; therefore, appraisal performance requirements or standards, regardless of their source, are not required
for waiver valuations by this rule. Since waiver valuations are not appraisals, neither is there a requirement for an appraisal review. However, the Agency
must have a reasonable basis for the waiver valuation and an Agency official must still establish an amount believed to be just compensation to offer
the property owner(s). The definition of "appraisal" in the Uniform Act and appraisal waiver provisions of the Uniform Act are Federal law and public policy
and should be considered as such when determining the impact of appraisal requirements levied by others. The values estimated are not based on a
valuation of the whole property, but pertain to the right -of -way acquired, as it is estimated to contribute to the whole. This is a restricted estimate made
under the Jurisdictional Exception provision in USPAP which allows governmental agencies to request and obtain valuation services for simple acquisitions
without causing licensed and certified appraisers to be in violation of USPAP. Also, per State guidelines, the estimator in connection with this assignment
did not contact the owners unless otherwise stated in this report.
The Waiver Valuation Report is a simple format report that allows governmental agencies to obtain valuation services for simple acquisitions. The values
estimated are not based on value of the whole property, but pertain to the land only, and specifically to the land acquired or encumbered, as it is estimated
to contribute to the whole.
R CLIENT IDEN
IC PURR0SE THE INTENDED IJ AND INTENDED USERsOO F�REPORT' i
Y.. P
The Client is identified as American Structurepoint, Inc. "Client" is defined by USPAP as "the party or parties who engage an appraiser (by employment or
contract) in a specific assignment The intended user of this report is American Structurepoint, Inc. as agents for the City of Carmel. The purpose of this
valuation is to estimate the fair market value to be used by the City of Carmel, for the purpose of acquiring the identified property rights from the owner of
record for this property, as of the effective date. The interest is "Fee Simple Estate" unless otherwise stated.
Urnt value of Land x $4.25 per square foot Signature
Name Printed Julie West
s, Falr`�Market Value t Fr $2,675.00 Date 6/8/2009 Appr. Lic. No. CG40400487
Iy Brok T Llcen`se No. 1820300226
Signature
Name Printed
Date Appr. Lic. No.
+Bro re AL N esn
Approved ,Total Due {Owner,
Minimum Award
Signature Date
Name Printed
Approved For Negotiations
Signature .�12 Date 2�
Name Printed
Acquiring Agency /Title
t
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
Christopher L. Covey and Tara L. Co Purchase Order No. NA
16 Lansdowne Lane Terms
Carmel IN 46033 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/18/09 NA 07 -08 Keystone Parkway 131st Street
Land Cost
Parcel 81 $3,962.00
Total $3,962.00
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.
Christopher L. Covey and Tara L. Covey ALLOWED 20
16 Lansdowne Lane IN THE SUM OF
Carmel IN 46033
3,962.00
ON ACCOUNT OF APPROPRIATION FOR
Christopher L. Covey and Tara L. Covey
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
DEPT.#
NA NA 4470502 63,962.00
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
September 14 20 09
$3,962.00 Signature
Cost distribution ledger classification if Cit En
claim paid motor vehicle highway fund Title