HomeMy WebLinkAbout230815 04/03/14 CITY OF CARMEL, INDIANA VENDOR: 146500
® ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $**"*"1,436.00*
a° CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 230815
10 N SENATE AVE CHECK DATE: 04/03/14
INDIANAPOLIS IN 46204-2277
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1,436.00 OTHER EXPENSES
�E..nnr INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
State Form 43283(07-08)
10 N.SENATE
` INDIANAPOLIS,AVE.46204-2277
-2' CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6
043283011
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03/1 1/2014 unemployment programs
6902378913283011 Set:1717 of 15389
CITY OF CARMEL Account/Location 133438
ONE CIVIC SQ Number
CARMEL IN 46032 Reporting Month 2/2014
Net Charges $1,411.00
Posting date 103/11/2014
STATEMENT OF BENEFIT CHARGES
CON FI DENT IAS RECORDS PURSUAN I TOiC 22-4-i 9-6, iC-4=1-66
The receipt of this statement does not reopen the question of the claimant's eligibility for unemployment insurance since
before the payments were made, the employer had the opportunity and the responsibility to report any information which
could disqualify the claimant.
Social Benefit Year Claim I Transaction Paid for
Security Employee's Name End Date Level Date Week Ending Acq Amount Charged
Number
THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THE DEPARTMENT. It is a statement of benefit charges
made to your account during the reporting month. If you are a Qualifying employer currently electing to be reimbursable,
this statement will be followed next month by your invoice (Form 1067).
" New charges for the reporting month 2/2014 '*
CHRIS VEACH 02/22/2014 UI 02/02/2014 02/01/2014 $177.00
Total New Charges for Reporting Month 2/2014 $1,436.0—-
" Reversed charges for the prior month 9/2011 ""
GREG A PARK 02/18/2012 UI 02/06/2014 09/03/2011 $25.000R
Total Reversed Charges/Credits for the Prior Month 9/2011 $25.000R
Total Amount of Net Charges $1,411.00
An (') in the Acq column denotes a charge resulting from an acquired business.
Marion County Toll Free (800) 437-9136.
END OF BENEFIT CHARGE STATEMENT
69023789 (1)
133438 35 - 6000972
NEWPARENT
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.201(Rev.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.
Payee
1 Lu__ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
L"T�
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
In (n ) j,,4jkLLOWED 20
VL Vv
IN SUM OF $
Z
ON ACCOUNT OF APPROPRIATION FOR
Board Members
INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.
# I hereby certify that the attached invoice(s),
d 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
0
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund