178473 10/20/2009 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE WANDY LOWRY
CARMEL, INDIANA 46032 CHECK AMOUNT: $10,000.00
CHECK NUMBER: 178473
'5 CHECK DATE: 10/20/2009
DEPARTMENT ACCOUNT PO NUMBER INVOIC NUMBER AMOUNT DESCRIPTION
920 4470502 10000.00 MOVING EXPENSES
Prescribed.by State Board of Accounts City Form No. 201 (Rev. 1995)
.4 ACCOUN'rs PAYABLE VOUCHER
CITY OF CAP MEL 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
Lowry, Wanda L. Purchase Order No.
810 E Main St Terms
Carmel, IN 46033 Date Due
Invoice Invoice Description
Date number or note attached invoices or bills Amount
Keysto 131st St
Parcel: 74 00
County.: Hamilton
Lum -Sum Relocation Payment in lieu of $10, 000
individual payments for down a ment
assistance, closing costs, and moving.
I 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 exeep
2009 Owner
Signature Wanda L. Lowry Title
1
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 2D
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION Board /Council Members
FOR
COST DISTRIBUTION LEDGER CLASSIFICATION
IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND
Acct. I Account Title Amount
No. I
1
r
A
z
F orm W Request for Taxpayer Give form to the
(Rev, O ct ober 2 007 Identification Number and Certification requester. Do not
De ➢uron+ent of Ihr Treasury i send to the IRS.
101 11 1 F'oV er1UE service
Name las shown on your income tax return)
CID Business narne. if ditfererd from above
G
C
°J C E cnech app oprlale box' i Ir�dfv dual /jpie I)ropnelor Corporation I�1 Partnership
a o r Exempt
11,11,100 Il L)'Wy cor FntCr Ine lax classillcahoo (0- disregarded entity, C- corporation, P- partnership}
p ayee
u
o I Ctrwr {x'E ir><uU01i(xtsf
c Aadress (numper, street, and ap(, or suite no,( Requester's name and address {optional}
.iZ City, slate, and ZIP code
CL
ID List account numbers) here optional) I
rn
Taxpayer Identification Num (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 (FIN). 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 idgnfificatlon number
number to enter.
Certificatiotl
Under penalties of perjury, I carllfy thal:
I 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 nor ,ubjecl to backup wilhhoiding because: (a) am exempt Irom 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, litem 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 Certificajion, but you must
provide your correct TIN. See the instructions on page 4.
Sig Signature of
Here u.s. person Date 1
Genera! Instructions d Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person it you are:
Section references are to the Internal Revenue Code unless
othe noted. An individual who is a U.S. citizen or U'.S. resident alien,
e A partnership, corporation, company, ar association Created or
Purpose of Forin 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 (i o An estate (other than a foreign estate), or
to report. for example, income paid to you, real estate a 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 Irorn such business, Further, in certain cases where a Form W
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to preSUFfie 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 1 ,N-9 to the partnership to estabilsh your U.S.
3. Claim exemption from backup withholding it you are a U.S. status and avoid withholding on your shale of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership incorne 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 fiornjthe 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 it it is lollowing cases:
substantially similar to this Form W -9. The U.S. owner of a disregarded entltyand not the entity,
Cat. No 10231X Form W -S (Rev. 10.2007)
I
CITY OF CARMEE,, IN
RELOCATION SPECIALIST REPORT
Name: Lowry, Wanda L. Project: 07 -08, Keystone 1 /131st
Address: 810 E. Main St., Carmel, IN 46032 Parcel: 74(00) Code: N/A
Type of Contact: Personal Visit Telephone Call (317) 846 -0464
Person Contacted Name: Lowry, Wanda L. Date: 10/14/2009
Address: 910 E. Main St., Carmel, IN 46032 Time:
Type of Relocation: Residential Owner
�Iouchcr Relocation Entitlements
Purpose: Ms, Lowry and 1. met to sign the voucher for relocation entitlements.
Amount: The City of Cannel agreed to pay Ms. Lowry $10,000 in lieu of individual payments for
downpayment assistance, closing costs /incidental expenses, and moving. The total of these individual
payments WOUld have been less than $10 Downpayment assistance would have been $2,500; the low
move estimate from Planes Moving Storage is 55,508.30; and closing costs /incidentals for a cash closing,
xhich Ms. Lowry eeag are typically around $500. The actual total would have been
approximately $8,500. +s scl �d—J-p -,f i--ur.
1
Requirement: Ms. Lowry has closed on her replacement dwelling and qualifies for the full payment
immediately. Ms. Lowry has indicated that she will manage the move to her replacement dwelling herself. I
will still assist her in any way possible to ensure that she completes the trove to the replacement successfully
and in a timely manner. i will conduct an inspection of the displacement dwelling once the move is complete
and take possession ofthe dwelling I'm the City.
Closing: All matters discussed are subject to the review and approval of the City of Carmel, N.
by Joe Gromosky
Displacce clocation Specialist
RA A P Form 0 8
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
Wanda L. Lowry Purchase Order No. NA
8 10 E. Main Street Terms
Carmel IN 46033 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/14 NA 07 -08 Keystone Parkway 131st Street
Relocation Cost
Pa rcel 74 $10,000.00
Total $10,000.00
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
v
VOUCHER NO. WARRANT NO.
Please forward check ALLOWED 20
to ,leremy Kashman
1 City of Carmel IN THE SUM OF
Engineer's Office
i
I
I
10,000.00
ON ACCOUNT OF APPROPRIATION FOR
Wanda L. Lowry
PO# or INVOICE NO, ACCT /TITLE AMOUNT Board Members
DEPT,#
NA NA 4470502 $10,000.00
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
October 15, 20 0
$10,000.00 Signature
Cost distribution ledger classification if City En
claim paid motor vehicle highway fund Title