HomeMy WebLinkAboutJIM VANSLAMBROOK -002066 -7/21/2011 fCARME!REDEVELOPMENT COMMISSION 002066
Jim VanSlambrook Check: 2066
842 Desert Wind Ct Date: 7/21/2011
Carmel, In 46032 Vendor: VANSLAM
Account: 382-50-7341
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Am t. Paid
105 590.00 590.00 0.00 0.00 590.00
Jazz on the Monon
590.00 590.00 0.00 0.00 590.00
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Jim VanSlambrook DATE: May 26, 2011
INVOICE# 105
FOR: Jazz on the Monon
842 Desert Wind Ct. 30-Jul-11
Carmel, IN 46032 BILL TO:
Carmel Redevelopment Commission
30 W. Main St, Suite 220
Carmel, IN, 46032
DESCRIPTION • AMOUNT
Slammer Jazz performance for Jazz on the Monon 590.00
Director ofReitle■rolopment/
9 33-9a3
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SUBTOTAL $ 590.00
TAX RATE 0.00%
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Make all checks payable to Jim VanSlambrook. SALES TAX
OTHER -
THANK YOU FOR YOUR BUSINESS! -
TOTAL $ 590.00
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)
.=-)Ames !U l r V 4
Q. Business name,if different from above
c
0
o-0 IndividuaV ❑ Exempt from backup
Check appropriate box: ❑ Sole proprietor ❑ Corporation El Partnership ❑ Other ► withholding
r H Address(number,street,and apt.or site no.) Requester's name and address(optional)
g 2 7)ass*-t r eV•�7'tom �7
ie City,stta g,and ZIP code
0 m List account number(s)here(optional)
a)
rn
Part 1. 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 number
backup withholding. For individuals,this is your social security number(SSN). However,for a resident ..I&12 t I ®+713 14(
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. I T I I I I I I
mmoi 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. I 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. I 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.)
Sign of '�/� �� y7 /ii/
Here U.S.person ► t-�Q Date ■ %J�
Purpose of Form • An individual who is a citizen or resident 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 • 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)
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