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226852 12/03/2013 CITY OF CARMEL, INDIANA VENDOR: 367781 Page 1 of 1 ONE CIVIC SQUARE KRISTINA UPTEGROVE �a CARMEL, INDIANA 46032 236 HOLLYBROOK DRIVE CHECK AMOUNT: $255.00 + NEW WHITELAND IN 46184 ,o CHECK NUMBER: 226852 CHECK DATE: 12/312013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 854 5023990 255 . 00 SPONSORSHIP Date: November 13, 2013 Invoice# 1004 Twisty Kristy TO City of Carmel Kristina Uptegrove Community Relations Dept. 236 Hollybrook Dr Attn: Megan McVicker New Whiteland, IN 46184 One Civic Square Twisty_ Carmel, IN 46032 kristy(cbhotmail.com (317)412-2063 CITY DESCRIPTION UNIT PRICE LINE TOTAL 3 hours Face Painting at Holiday in the Arts District,December 14,2013 $150/hr $450 Discount -$195 SUBTOTAL $255 SALES TAX 0 TOTAL $255 Make all checks payable to Kristina Uptegrove Thank you for your business! i ! orm Request for Taxpayer (dive Form to the ! v.August 2013) identification Number and Certification requester.Do not artment of the Treasury Send to the IRS. ntemal n-102e Service i Name(as shown on your Income tax retum) Kristin U t rove Business namefdasregarded name,If different from above ` a entity Twist Krist i ! Check appropriate box for federal tax classification; Exemptions(see instructions): Individual/sole proprietor ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate I � exempt payee code(f any) © Urnited liability company.Enter the tax classification(C+C corporation,S=S corporation,P=partnership)► Exemption from FATCA reporting code(if any) ! ❑ Other(see instructions)1► Address(number,street,and apt.or suite no.) Requester's name and address(optional) 236 Holl brook Drive City of Carmel city,state,and ZIP code Attn:Sharron Kibbe I} 1 Civic Square N New Whiteland,IN Carmel,Indiana 46432 i E Llat eceount numt)043)hero(optional) �I Taxpayer Identification Number(TIN) ter your TIN in the appropriate box,The TIN provided must match the name given on the"Name"line Social security number o avoid backup withholding,For individuals,this Is your social security number(SSN),However,for a ! esident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other KEE I I Nona it is your employer identification number(EIN).If you do not have a number,a"Now to get a page 3. ote.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer IderdtfGa—don number umber to enter. F51 - 3 8 0 3 8 7 8 i. I I Certiflcatlon ' fj nder penalties of perjury,I certify that: I; ! I The number shown on this form is my correct taxpayer identification on number(or I am waiting for a number to be issued to me),and . 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 I am a U.S.citizen or other U.S.person(defined below),and .The FATCA code(s)entered on this form Of any)indicating that I am exempt from FATCA reporting Is correct. Ication Instructions,You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding i ause you have failed to report all interest and dividends on your tax return.,For real estate transactions,Item 2 does not apply.For mortgage West paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and ! enerally,payments other than.interest and dividends,you are not required to sign the certification,but you must-provide your corrscfTlN.See the structions on page 3. G Ign 9rgnidure of _ ere I U.B.peryvn► oats. - en®r$I Ins tructions U withholding tax on foreign partners'share of effectively connected income,and lion references are to the Internal Revenue Code unless otherwise noted. 4.Certify that FATCA code(;)entered on this form(if any)Indicating that you are 3 devtopmend►.The IRS has created a page on 1R$.90v for Information exempt from the FATCA reporting,is correct. Form W-9,at www.lrs;gov 1w9.Information about any future developments Note-It You are a U.S.person and a requester gives you a form other than Form { ing Form W-9(such as legislation enacted after we release it)will be posted W-9 to request your TIN,you must use the requester's form if it is substantially that page, similar to this Form W9. rpose of Form Deflnttton of a U.S.person.For federal tax purposes,you are considered a U.S. Person If you are: Person who Is required to rite an Information return with the IRS must obtain your •An Individual who Is a U.S.citizen or U.S.resident alien, rrect taxpayer Identification number(TIN )to report,for example.Income paid to •A partnership,corporation,company,or association created or organlzed in the r j Payments made to you in settlernent of payment card and third party network United States or under the laws of the United States, ) ions,real estate transactions,mortgage interest you paid,acquisition or donment of secured property, •An estate(other than a foreign estate),or an IRA, p ��cancellation of debt,or conhibutlons you made t •.A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to Special rules for partnerships.Partnerships that conduct a trade or business in Ida your correct TIN to the person requesting It(the requester)and,when the United States are generally required to a a withholding tax under section Ilgable,to: 1446 on any foreign partners'sham of effeat'rvey eonhected taxable income from r I Certify that the TIN you are giving is correct(or you are waiting for a number such business.Further,in certain uses where a Form W.9 has not been received, issued), the rules under section 1446 require a partnership to presume that a partner is a Certify that you are rat subject to backup wlthholdin fon91gn person,and pay the sectlpn 1446 withholding tax,Therefore,if you are a g•or U.S.person that is a partner In a partnership conducting a trade or Wsinsea In the Claim exemption from backup withholding if you are a U.S,exempt payee.If United States,provide Form W-9 to the partnership to establish your U.S.status Ilcable,you are also certifying that as a U.S.person your allocabte share of and avoid section 1446 withholding on your share of partnership income. partnership income from a U.S.trade or business is not subject to the I Cat.No.10231X Form W-9(Rev.8-2013) TO 39dd b98 r d39OdA 8bTb-E88-LT6 OS:TT CIOZ/Z0/ZT VOUCHER NO. WARRANT NO. ALLOWED 20 Kristina Uptegrove IN SUM OF $ 236 Hollybrook Drive New Whiteland, IN 46184 $255.00 ON ACCOUNT OF APPROPRIATION FOR Community Relations Gift Fund 854 PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 854 I 1004 I - I $255.00 1 hereby certify that the attached invoice(s), or C bill(s) is (are)true and correct and that the '�O. p materials or services itemized thereon for which charge is made were ordered and received except Monday, December 02, 2013 Director, Com4dnity Relations/Economic Development Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 10/08/13 1004 $255.00 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