247892 07/28/15 ,CSN .
4��...,,'" CITY OF CARMEL, INDIANA VENDOR: L2370
® '1 ONE CIVIC SQUARE I N S C C U-ASFE CHECK AMOUNT: $######•440.00'
_.. ?� CARMEL, INDIANA 46032 PO BOX 6271 CHECK NUMBER: 247892
*,:__�N INDIANAPOLIS IN 46206-6271 CHECK DATE: 07/28/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 440.00 OTHER EXPENSES
1
Order to Withhold Income
® for the 2015 Indiana Annual Support Fee
' Indiana Department of Child Services
State Child Support Bureau
Per Indiana Statutes IC-33-37-5-6 and IC-31-16-15
ASFEIWO 07/13/2015
- CITY OF CARMEL
ONE CIVIC SQUARE
ATTN KAREN HUFFMAN
CARMEL IN 46032
This is an Order to Withhold Income for the 2015 Annual Support Fee. This fee is charged to non-custodial parents pursuant to
Indiana stabate. You are required by law,IC-313-37-55-6 and IC 3:46-I5,to..,..U.l .amounts from the-employee's income. The— -
deduction should be made from the next payroll,or as soon thereafter as practical. You may remit either in check form,which should be
forwarded to the Indiana State Central Collection Unit(INSCCU),or electronically(please see instructions below). This deduction is in
addition to any other child support or support-related payments you may be deducting.
• General information:
• This is a once a year fee deduction that should be made AFTER all other child support payments are deducted. If the child
support obligation deducted each pay period always exceeds the CCPA limits,you cannot withhold the fee. The child
support obligation,your fee,plus the ASFE combined,cannot exceed the CCPA limits.
• Even if you are not currently withholding child support for the employee(e.g. the non-custodial parent is paying directly),
$ the ASFE fee still needs to be withheld. Employees with questions should contact the Kidsline at 317-233-5437 or 800-
840-8757.
• A separate payment is required for this fee; do not combine the fee with regular child support payments.
• You may retain a two dollar(52.00) fee from the employee's income for this withholding.
• Even if the child support obligation ceased within the current year,the fee is neither waived nor prorated.
• Paying via Check:
• Please complete the list on the reverse of this letter and send it with the payment to the address listed on the reverse. A
copy of this list MUST accompany the payment,unless payments are sent electronically.
• Please note that the P. O. Box for the fee payments is different than for regular child support payments.
• If possible,please combine the Annual Support Fees withheld from all employees listed in a single check.
• Paving Electronically:
• The fee can be paid by using the Child Support Bureau's FREE Employer Online Payment System. If you're not currently
using the site to process your regular child support payments,we can set you up to process the fees only. For more
_;rfnrmatie_^_concerning r?�s-process,please-call-317-23241327 or 1_-800-29270403,ontion 1. –
• The fee CAN NOW also be sent electronically(ACH)but you must follow these instructions. Set up the fee as a
separate child support deduction and add ASFE to the beginning of the ISETS case number as shown on the reverse of this
document. ADP clients must use the P O Box 6219 as the payee address and add ASFE to the beginning of the ISETS
case number,as only payments with this address will go electronically to Indiana. Ceridian clients must assign the
garnishment INSDUI for the payments to go electronically.
Consumer Credit Protection Act(CCPA): Federal law requires states to limit the amount which can be collected by income withholding
to 60%of disposable earnings per pay period,or 50%of disposable earnings if your employee is supporting another spouse or
dependent child(current family). If earnings are not sufficient to make the full payment(which may include the$2.00 fee),partial
deductions should be made up to the CCPA limit.
If you have any questions,please contact the Child Support Bureau,EMPLOYER MAINTENANCE UNIT(EMU)at 317-232-0327 or
1-800-292-0403 or EMU@DCS.fN.gov.
SIGNATURE
Cynthia Longest
Deputy Director
Department of Child Services
1 of 2 Child Support Bureau
THE EMPLOYEES LISTED BELOW OWE THE 2015 INDIANA ANNUAL SUPPORT FEE.
• The remittance for the Annual Support Fee must be mailed separately to the special ASFE P O Box address listed
below.
• You are not obligated to make a payment for employees/income payees listed if he/she is no longer employed by your
company. If there is an outstanding paycheck, send the amount requested from the list below while not exceeding the
CCPA limits. If an employee/income payee is not employed by your company,please complete column 3 of the list
and fax to(317) 232-0290.
Please retain a copy of the completed list for your records.If additional or multiple
payments are needed,a copy of this list is to be sent with your payments.
Employer Name: CITY OF CARMEL
DBA: Make Check Payable to:
FEIN: 356000972 INSCCU - ASFE
P O Box 6271
Indianapolis IN 46206-6271
Employee's Name Emplo"yee"s', Date of Last Day,,-,, ISETS Case# Amount Amount`
SSN Worked:'or, Due , Paying .
Never Employed per case per case
BROWNING, TIMOTHY ✓
$55.00
2 of 2
i
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.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
L/ -' /-�S,GCs Purchase Order No.
,f' O (D/oi 71 Terms
V,,l 2(,� " ryo��/ Date Due
Invoice Invoice Description Amount
(or note attached invoice(s) or bill(s))
SS�da
Lj
o-,
O-D
Jr F
Total Vy 0' V-D
I 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
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
/N`s C C 61 — IN SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or DEPT# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
-6-0,z3�21v ,S$,a-b bill(s) is (are) true and correct and that the
O'D materials or services itemized thereon for
d-D which charge is made were ordered and
0.2 1S.(�J received except
a 20 1,5-- -
Signa
Title✓
Cost distribution ledger classification if
claim paid motor vehicle highway fund