Okaloosa County BOCC — March 15, 2016 — My Kids Money invoice

My Kids Money, LLC INVOICE ¢/o Farris, Self & Moore, LLC P.O. Box 121859 Nashville, TN 37212 DATE: March 2, 2016 Phone (615) 760-5107 BUDGET# MKM20160302 MKM Federal ID # 47-3754802 PO # Artist: Chris Janson Bill To: Okaloosa County Attn: Charlotte Dunworth 1250 Miracle Strip Parkway SE FT Walton Beach, FL 32548 Chris Janson - May 12, 2016 Emeral Coast Convention Center - Balance of show pay $ 20,000.00 ("o For BCC AGEMDA pugposes oMY ¥vo woT PANK TOTAL | $ 20,000 Please issue Direct Deposit to My Kids Money, LLC bank account (on file) Feel free to email hollister@smnash.com with any questions o W=9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. My Kids Money, LLC 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above [ individual/sole proprietor or [ c corporation single-member LLC the tax classification of the single-member owner. D Other (see instructions) > 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: D S Corporation D Partnership Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) » P Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) |:| Trust/estate 5 Address (number, street, and apt. or suite no.) P.O. Box 121859 Requester's name and address (optional) 6 City, state, and ZIP code Nashville, TN 37212 Print or type See Specific Instructions on page 2. 7 List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part | 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. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. | Social security number or | Employer identification number 47| -{3|7|5|4|8|0]|2 Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and 2. | am not subject to backup withholding because: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Service (IRS) that | 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 | am no longer subject to backup withholding; and 3. lam a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct. 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 £o sign the certification, but you must provide