173605 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: T361402 Page 1 of 1
ONE CIVIC SQUARE TIM WOMICK CHECK AMOUNT: $850.00
CARMEL, INDIANA 46032 1087 CAMDEN CT
ASHEBORO NC 27203 CHECK NUMBER: 173605
CHECK DATE: 6/1012009
DEPAR ACCOU PO NU MBER IN NUMBER AMO UNT DESC
1192 4340400 241 -C 850.00 CONSULTING FEES
TO: City of Carmel 1 Z 3 4 .5
Scott Brewer, City Forester
One Civic Square
Carmel, IN 46032 Q ��GEI�IED
A ?ft
FROM: Tim Womick
1087 Camden Court
Asheboro, NC 27203
DATE: April 28, 2009
MEMO: April 25, 2009 Arbor Day Appearance Fee
INVOICE: #241 -C
Amount due: $850.00
Thanks for your continued support!
1 Request for Taxpayer Give form to the
kf Rev. Jan 5) requester. Do not
cb Partrnentof t .4, ury Identification Number and Certification send to the IRS.
renal R venue
game (a btn wno your income tax eturn)
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d MAY Business if different from ov
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T o Ind iy Exempt from backup
Ch ra ropriate box: ore proprietor Corporation Partnership Other withholding
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ss (number, street, and apt. or suite no.) Requester's name and address (optional)
Q. C
Cify, state, and ZIP code
CL
020 G 2"l Z. 0 3
a) List account number(s) here (optional)
a>
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 Social security
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 number Employer identification 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. 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 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.)
N.
Sign Signature of
Here U.S. person 0 Date
Purpose of Form
A person who is required to file an information return with the Y Any estate (other than a foreign estate) or trust. See
IRS, must obtain your correct taxpayer identification number Regulations sections 301.7701 -6(a) and 7(a) for additional
(TIN) to report, for example, income paid to you, real estate information.
transactions, mortgage interest you paid, acquisition or Foreign person. If you are a foreign person, do not use
abandonment of secured property, cancellation of debt, or Form W -9. Instead, use the appropriate Form W -8 (see
contributions you made to an IRA. Publication 515, Withholding of Tax on Nonresident Aliens
U.S. person. Use Form W -9 only if you are a U.S. person and Foreign Entities).
(including a resident alien), to provide your correct TIN to the Nonresident alien who becomes a resident alien.
person requesting it (the requester) and, when applicable, to: Generally, only a nonresident alien individual may use the
1. Certify that the TIN you are giving is correct (or you are terms of a tax treaty to reduce or eliminate U.S. tax on
waiting for a number to be issued), certain types of income. However, most tax treaties contain a
provision known as a "saving clause." Exceptions specified
2. Certify that you are not subject to backup withholding, in the saving clause may permit an exemption from tax to
or continue for certain types of income even after the recipient
3. Claim exemption from backup withholding if you area
U.S. exempt payee. has otherwise become a U.S. resident alien for tax purposes.
Note. If a requester gives you a form other than Form W -9 to If you are a U.S. resident alien who is relying on an
request your TIN, you must use the requester's form if it is exception contained in the saving clause of a tax treaty to
substantially similar to this Form W -9. claim an exemption from U.S. tax on certain types of income,
you must attach a statement to Form W -9 that specifies the
For federal tax purposes you are considered a person if you following five items:
are: 1. The treaty country. Generally, this must be the same
9 An individual who is a citizen or resident of the United treaty under which you claimed exemption from tax as a
States, nonresident alien.
a A partnership, corporation, company, or association 2. The treaty article addressing the income.
created or organized in the United States or under the laws 3. The article number (or location) in the tax treaty that
of the United States, or contains the saving clause and its exceptions.
Cat. No. 10231X Form W -9 (Rev. 1 -2005)
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/08/09 241 -C Arbor Day Appearance $850.00
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
Timothy H. Womick
1 1 IN SUM OF
1087. Camden Ct.
Ashboro, NC 27203
$850.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1192 241 -C 43- 404.00 $850.00 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
Mon ay, Jrne 08, 2009
i ctor, DO
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund