ELY ENTERPRISES, LLC- 002952- 6/21/2012 CARMEL REDEVELOPMENT COMMISSION
002952
Ely Enterprises, LLC Check: 2952
336 West Main Street Date: 6/21/2012
Carmel, IN 46032 Vendor: ELY ENTE
Prior
Invoice
P.O. Num. Invoice Amt Balance Retention Discount Amt. Pai
103 600.00 600.00 0.00 0.00 600.0
Blair Clark Jazz on the Monon
.600.00 600.00 0.00 0.00 600.0
•
ISNINSTHE KEYJO DOCUMENT,,SEOURITYZHEAT,ACTIVATEDIITHUMB PRINTRADDITIONMISECURIT.Y,FEATURES INCLUDEDZSEE.BACK FOR DETAILSNM
I
.'t16 Disk. Carmel Redevelopment Commission 00 2 9 5 2
1 Ar30 West Main Street A REGIONS
L_ Suite 220 20.1421/740
o;"`v1L4.„,,i Carmel, IN 46032
TRIG
I
DATE 2952
1 AMOUNT
' PAY THE SUM OF SIX HUNDRED DOLLARS AND NO CENTS 6/21/2012 soap-
;
TO THE
ORDER
OF Ely Enterprises, LLC
i 336 West Main Street
+ Carmel, IN 46032
M
if
000295211' 1:0740142131: 0087504 L l 111 l AMR
Ely Enterprises, LLC HATE: June 11,2012
INVOICE# 103
FOR: Jazz on the Monon
336 W. Main Street 23-Jun-12
Carmel, IN 46032 BILL TO:
Carmel Redevelopment Commission
30 W. Main St, Suite 220
Carmel, IN,46032
DESCRIPTION AMOUNT
Blair Clark performance for Jazz on the Monon $ 600.00
SUBTOTAL $ 600.00
TAX RATE 0.00%
Make all checks payable to Ely Enterprises,LLC. SALES TAX -
OTHER -
THANK YOU FOR YOUR BUSINESS!
TOTAL $ 600.00
eCij
f
F.F. W'9 Request for Taxpayer Give Form to the
(Rev.Deee'nber2011) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name(as shown on your income lax return)
Ely Enterprises, LLC
N Business name/disregarded entity name.If different from above
a
rn
m
Check appropriate box for federal tax classifiation:
0
❑ Individual/sole proprietor ❑ C Corporation ❑ S Comoretbn ❑ Partnership ❑Trust/estate
$c
0
it ❑ Limited liability company.Enter the tax classification(C=C corporation.S=S corporation,P=partnership)• p ❑Exempt payee
'a 2
c
u ❑ Other(sae instructions)•
L Address(number,street,and apt.or suite no,) Requester's name and address(optional)
U
$ 336 W.Main St.
a Ci
o ly.state,and ZIP code
CO• Carmel,IN 46032
List account numbegsl here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line i Social security number
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 -I i lI I -
entities,it is your employer identification number(EIN).If you do not have a number,see How to get e
TIN on page 3.
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.
4 5 - 2 5 1. 2 3 8 9
Part II Certification
Under penalties of perjury,I certify that:
1. The number shown on this lorm 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.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.
Sin Siature of Here u.s person 1�11�iG
Date
General Instructions Note.If a requester gives you a form other than Form W-9 to request
your TIN,you must use the requester's form if it Is substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted. Definition of a U.S.person.For federal tax purposes,you are
Purpose of Form considered a U.S.person if you are:
A person who is required to file an Information retum with the IRS must •An individual who is a U.S.citizen or U.S.resident alien,
obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or
example,income paid to you,real estate transactions,mortgage Interest organized in the United States or under the laws of the United States,
you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or
of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7).
Use Form W-9 only if you area U.S.person(including a resident
alien),to provide your correct TIN to the person requesting It(the Special rules for partnerships.Partnerships that conduct a trade or
requester)and,when applicable,to: business in the United States are generally required to pay a withholding
tax on any foreign partners'share of income from such business.
1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received e
number to be issued), partnership Is required to presume that a partner is o foreign person,
2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,If you are a U.S.person that is a
3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United
payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S.
allocable share of any partnership income Irom a U.S.trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.12-2011)
Prescribed by State Board of Accounts Oily Form No-201(Nov.1996)
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
/SPY fey,/, “.G Purchase Order No.
3 36 Gt/Pvt /1�y, Terms
GA.-Mr"7. /w '76,32- Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11-72 407 L - +ref n.,- 6,c9 .of)
nl
.'Y
Total cz, 'd0 = •.wl±
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have a.dite. same in accor-
dance with IC 5-11-10-1.6. q'
Co , 20 IL i� o
er -Treasurer