223442 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367492 Page 1 of 1
ONE CIVIC SQUARE CRAIG HACKER PHOTOGRAPHY
CARMEL, INDIANA 46032 PO Box 1027 CHECK AMOUNT: $232.05
WICHITA KS 67201
CHECK NUMBER: 223442
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 082113-2 232 . 05 OTHER CONT SERVICES
DATE
August 21,2013 91i1sVO10E
00 D4 TO
Denise Snyder
cra ig AMR Carmel Fire Department
p h o t o g r a p h y 2 Civic Square
Carmel,IN 46032
OFFICE USA
P.O.Box 1027 317-571-2622
Wichita,KS 67201-1027
PHONE PROJECT TITLE:2013 CPSE Awards Banquet
316-393-7606
PROJECT DESCRIPTION:Reprints
EMAIL
P.O.NUMBER:
craig @craighacker.com
INVOICE NUMBER:082113-2
WEB
www.craighackencom TERMS:Net 30 days
TAX ID NO.
510-74-7724 Si61� G33 EIF
8X 10"Color Reprints- 9 $ 24.95 $ 224.55
Lustre
Shipping 1 $ 7.50 $ 7.50
SUBTOTAL $ 232.05
Tax
Total $ 232.05
Form Request for Taxpayer Give form to the
(Rev.October 2007) Identification Number and Certification requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name(as shown on your income tax return)
Craig A. Hacker
CU Business name, if different from above
Q.
Craig Hacker Photography
0
n c Check appropriate box: ® Individual/Sole proprietor ❑ Corporation ❑ Partnership Exempt
�•2 El Limited liability company. Enter the tax classification(D=disr e9 ar ded entity,C=cor P oration, P=P art nershi P) ► _______ payee
❑
p i ❑ Other(see instructions)
C Address(number,street,and apt.or suite no.) Requester's name and address(optional)
a P.O.Box 1027
w
City,state,and ZIP code
N Wichita KS 67201-1027
List account number(s)here(optional)
Cl)
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 510 :1 74 :17724
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.
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 d divid nds,you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign Signature of
Here U.S.person P- Date D 4/17/12
General Instructions n of a U.S. person. For federal tax purposes, you are
?efi-ition
nsidered a U.S. person if you are:
Section references are to the Internal Revenue Code unless An
otherwise noted. individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
Purpose of Form 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(TIN) • An estate(other than a foreign estate), or
to report, for example, income paid to you, real estate o 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 from such business. Further, in certain cases where a Form W-9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume 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 W-9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income 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 from the 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 if it is following cases:
substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity,
Cat.No. 10231X Form W-9 (Rev.10-2007)
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))
082113-2 $232.05
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
Craig Hacker Photography
IN SUM OF $
P.O. Box 1027
Wichita, KS 67201
$232.05
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 082113-2 I 43-509.00 I $232.05 1 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
2013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund