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Home My WebLink AboutROB DEROCKER - 3139 - 11,138.92 - 9/4/2012 CARMEL REDEVELOPMENT COMMISSION Rob DeRocker Check: 3139 3 Warner Lane Date. 9/4/2012 Tarrytown, NY 10591 Vendor: DEROCK01 Prior Invoice P.o. Num. Invoice Amt Balance Retention. Discount Amt. Paid 080112 11 ,138.92 11,138.92 0.00 0.00 11 138.92 July fees and expenses 11,138.92 11, 38.92 0.ao 0.00 - 11,138.92 x 11 52 COMPUTEREASE FORMS DIVISION(8T7)577-5791 T-7177.1 Form -9 Request for Taxpayer Give form to the (Rev.November2005) Identification Number and Certification requester. Do not D epartment at the treasury send to the IRS. Infant Revenue Service Name(as shown on your Income tax return) 0 Robert E.DeRocker a Business name.If different from above O • a a O FA Individual/ Exempt from backup 1▪ Check appropriate box: Sole proprietor ❑ Corporation ❑ Partnership El Other (—I withholding `o t m Address(number,street and apt.or suite no.) Requester's name and address(opilonaff u So 3 Wamer Lane So t City.state,and ZIP code Tarrytown,NY 10591 W List account number(s)here(optional) y 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 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. Part II 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,pa - other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.(See t • s • page 4.) rir Sign Signature of / Date j 3\‘ ‘.\.\(��\ Here U.S.person es Purpose of For a 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 o 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 o 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 it 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 3. Claim exemption from backup withholding H you are a presume that a partner is a foreign person, and pay the 3 i U.S. exempt a payee. withholding tax.Therefore, if you are a U.S. person that is a 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 o The U.S. owner of a disregarded entity and not the entity, are: Cat.No. 10231X Form W-9 (Rev.11-2005) ROB DEROCKER 3 WARNER LANE TARRYTOWN, NY 10591 917-658-4653 INVOICE Date: August 1, 2012 Client: Carmel Redevelopment Commission For: Public Relations Services, July 1-31, 2012 Professional Fees: $9,150.00 Out of Pocket Expenses New York Media/Site Consultant Meetings: $734.54 Washington DC Media Meetings: 1,254.38 TOTAL: $11,138.92 • ROB DEROCKER 3 WARNER LANE TARRYTOWN, NY 10591 917-658-4653 INVOICE Date: August 1, 2012 Client: Carmel Redevelopment Commission For: Public Relations Services, July 1-31, 2012 Professional Fees: $9,150.00 Out of Pocket Expenses New York Media/Site Consultant Meetings: $734.54 Washington DC Media Meetings: 1,254.38 TOTAL: $11,138.92 ROB DEROCKER EXPENSE REPORT STAFF NAME: Rob DeRocker DATE : 06/06/12 July site consultant/ media appointments in New York with Mayor SUMMARY OFfEXP.ENSES FINANCE'USE ONLY VOUCHER# `: TOTAL CREDIT.i ' ' . • 'fr$704;54' TOTAL CASH TOTAL $734.54 EXPENSE CREDIT CASH ACTIVITY DATE EXPENSE DESCRIPTION ACCOUNT# EXPENSE EXPENSE 7/17/12 Dinner with NYTimes writer Jane Levere 529.90 7/16/12 Lunch with Mayor 54.83 7/16/12 cabs in New York 30.00 7/17/12 Muffin 2.00 7/17/12 Lunch at NY Times 9.81 7/16/17 Metro North to/from Tarrytown to NY 108.00 $704.54 $30.00 ROB DEROCKER EXPENSE REPORT STAFF NAME: Rob DeRocker DATE : 08/06/12 Media appointments in Washington with Mayor 7/30-31 SUMMARY OFTEXP.ENSES' r ; ' r' ", � FINANCE`USE ONLY w VOUCH E R# TOTAL CREDIT l $1 145.38 TOTAL:CASH.: . _ $109.00' TOTAL $1,254.38 EXPENSE CREDIT CASH ACTIVITY DATE EXPENSE DESCRIPTION ACCOUNT# EXPENSE EXPENSE 7/30/12 Amtrak to Washington DC 194.00 7/31/12 Amtrak to New York 242.00 7/31/12 Hotel in DC 250.76 7/30/12 Lunch for Mayor, et. at with German reporter 158.77 7/30/12 dinner with ABC affiliate assignment editor 153.35 7/31/12 breakfast for Mayor,et. al with AP reporter 115.10 7/30/12 car service from USA Today 60.00 7/30/12 breakfast in Penn Station 7.40 7/30/12 snack on Amtrak 2.00 7/31/12 cabs in DC 47.00 7/30/12 Metro North to/from Manhattan to catch train 24.00 $1,145.38 $109.00 • ROB DEROCKER ' EXPENSE REPORT STAFF NAME: Rob DeRocker DATE : 08/03/12 July site consultant/media appointments in New York with Mayor SUMMARY OF EXPENSES FINANCE USE ONLY VOUCHER St TOTAL CREDIT r $704.54 TOTAL CASH $30.00 TOTAL $734.54 EXPENSE CREDIT CASH ACTIVITY DATE EXPENSE DESCRIPTION ACCOUNT# EXPENSE EXPENSE 7/17/12 Dinner with NYTimes writer Jane Levere 529.90 7/16/12 Lunch with Mayor 54.83 7/16/12 cabs in New York 30.00 7/17/12 Muffin 2.00 7/17/12 Lunch at NY Times 9.81 7/16/17 Metro North to/from Tarrytown to NY 108.00 $704.54 $30.00 ROB DEROCKER ' EXPENSE REPORT STAFF NAME: Rob DeRocker DATE : 08/03/12 Media appointments in Washington with Mayor 7/30-31 SUMMARY OF EXPENSES FINANCE USE ONLY VOUCHER# TOTAL CREDIT i $1,145.38 TOTAL CASH $109.00 TOTAL $1,254.38 EXPENSE CREDIT CASH ACTIVITY DATE EXPENSE DESCRIPTION ACCOUNT# EXPENSE EXPENSE 7/30/12 Amtrak to Washington DC 194.00 7/31/12 Amtrak to New York 242.00 7/31/12 Hotel in DC 250.76 7/30/12 Lunch for Mayor,et. at with German reporter 158.77 7/30/12 dinner with ABC affiliate assignment editor 153.35 7/31/12 breakfast for Mayor,et. al with AP reporter 115.10 7/30/12 car service from USA Today 60.00 7/30/12 breakfast in Penn Station 7.40 7/30/12 snack on Amtrak 2.00 7/31112 cabs in DC 47.00 7/30/12 Metro North to/from Manhattan to catch train 24.00 $1,145.38 $109.00 r I' Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rey.1995) 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. r1 p7 //'' Payee 1J4 /,/r �o4Ker Purchase Order No. 3 c'l/n-.rr< La/;e Terms pr-774oroer, in'/659/ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5)--/-(2 5o/ /2 Td> ,ZO/2 -'C ' 5 e7--e • /c /3g? 92- Total 8i/, •y2 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and ice• •ited same in accor- dance with IC 5-11-10-1.6. �� CPA , 20 t2 erk- reasurer VOUCHER NO. WARRANT NO. QQ ALLOWED 20 /l 0. 0,40c c ,- �" IN SUM OF $ 3 je2ny7ri- jvrr /21264/, /✓Y /C:59/ $ /7) AD- 92 ON ACCOUNT OF APPROPRIATION FOR got Board Members PO# n INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), 9a2 5- o/ ( Sr jy0yoo )1,1 92_ 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 ?--#3 20 I'2_ W Signature Executive Director Title Cost distribution ledger classification if Carmel Redevelopment Commission claim paid motor vehicle highway fund