The URL can be used to link to this page

Home My WebLink About221717 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 364216 Page 1 of 1 ONE CIVIC SQUARE KELLEEN STRUTZ CARMEL, INDIANA 46032 917 E 78TH ST CHECK AMOUNT: $600.00 INDIANAPOLIS IN 46240 CHECK NUMBER: 221717 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1203 4359003 080313 600 . 00 FESTIVAL/COMMUNITY EV INVOICE: 080313 JULY 1, 2013 KELLEEN STRU°TZ 917 E. 78" Street Indianapolis, IN 46240 TO: CITY OF CARMEL Community Relations Department One Civic Square Carmel, IN 46032 DESCRIPTION TOTAL JAZZ ON THE MONON PERFORMANCE August 3, 2013 $600.00 TOTAL $600.00 I Make all checks payable to KELLEEN STRUTZ f E THANK YOU FOR YOUR BUSINESS! Form Request tow Ta";tpayeff Give Form to the (Rev.,Wcember 2011) requester.Do not of the Tye�sm Odentification Mumbe? and CeutificatOon send to the IRS. =art S-.111anue Service Name(as shown on your income tax retum) ,kE--/ --,A,,/ --' , --�Q _,�.IE:f: J _5 / I (,) , N Business narnefdisregarded entity name,if different from above ID ca 0) Check appropriate box for federal tax classification: c: t 0 Individuallsole proprietor ❑ c corporation ❑S Corporation ❑ Partnership ❑Trust/estate a CL o Limited liability company.Enter the tax classification(C=C corporation, ❑S--S corpon0on,P=partnership)b, 0 Exempt payee 0 —--—---------------—--------- r ❑ Other(see instructions)b !E Address(number,street and apt.or suite no.) Requester's name and address(optional) U 4) CL V) CD City,state,and ZIP code M List account numbw(s)here(aptibnai) --- 3xpayerldentification Number MN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"fine Social y � 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(BN)-If you do not have a number,see How to get a 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 Wm*F=a&m comber number to enter. M M�= 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 carried TIN.See the instructions on page 4. Sign $7:9natLTe Of Here U.S I person® _ Date c- -5 GeneraO Instructions (dote.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 M to the Internal Revenue Code unless otherwise noted. to this Form W-9, Deftnition of a U.S.person.For federal tax purposes,you are Purpose of Fonn considered a U.S.person if you are: A person who is required to file an information return with the IRS must -An individual who is a U-S.citizen or U.S.resident alien, obtain your correct taxpayer identification number MN)to report for a 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,'o,r contributions you made to an IRA. Use Form W-9 only if you are a U.S.person(including a resident o A domestic trust(as defined in Regulations section 301.7701-7). alien),to provide your correct TIN to the person requesting it(the Special rates 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 1.Certify that the TIN you are giving is correct(or you are waiting for a tax on any foreign partners'share of income from such business. number to be issued), Further,in certain cases where a Form W-9 has not been received,a partnership is required to presume that a partner is a 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.ClaW exemption from backup withholding if you are a U.S.;exempt partner in a partnership conducting a trade or business in the United payee.Iftapplicable,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 from 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 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)) 07/01/13 080313 $600.00 1 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 Kelleen Strutz IN SUM OF $ 917 E. 78th Street Indianapolis, IN 46240 $600.00 ON ACCOUNT OF APPROPRIATION FOR Community Relations PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 26 1 080313 j 43-590.03 j $600.00 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 except Monday, July 01, 2013 Director, Community Relations/Eco omic Development Title Cost distribution ledger classification if claim paid motor vehicle highway fund