HomeMy WebLinkAbout248209 08/12/15 CITY OF CARMEL, INDIANA VENDOR: 146500
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $*****1,920.00*
CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 248209
9\ 10
N SENATE AVE CHECK DATE: 08/12/15
INDIANAPOLIS IN 46204-2277
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 R4110000 36472 676277 1,920.00 UNEMPLOYMENT FEES
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
State Form
83(07
10 SENATE E 8)
202
INDIANAPOLIS,IN 46204-2277
�e16. CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6 043283011
IRK :D GHQ, link
08/03/2015 unemplopmentpu ams
AUG - 1 2115
7652433313283011 Set:8897 of 9246 BY.:
CARMEL CLAY BOARD OF PARKS AND RECREATION Account/Location 676277
1411 E 116TH ST Number
CARMEL IN 46032-3455 Reporting Month 7/2015
Net Charges $1,920.00
Posting date 08/03/2015
STATEMENT OF BENEFIT CHARGES
CONFIDENTIAL RECORDS PURSUANT TO IC 22-4-19-6, 1C 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 Transaction Paid for
Security Employee's Name End Date Level Date Week Ending Acq Amount Charged
Number
o,
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 7/2015 ***
XXX-XX-9085 JEFFREY P KRAMER 04/16/2016 UI 07/05/2015 07/04/2015 $390.00
XXX-XX-9085 JEFFREY P KRAMER 04/16/2016 UI 07/12/2015 07/11/2015 $390.00
XXX-XX-9085 JEFFREY P KRAMER 04/16/2016 UI 07/19/2015 07/18/2015 $390.00
XXX-XX-9085 JEFFREY P KRAMER 04/16/2016 UI 07/26/2015 07/25/2015 $390.00
XXX-XX-4499 LORNE M BAXTER 08/01/2015 UI 07/05/2015 07/04/2015 $120.00
XXX-XX-4499 LORNE M BAXTER 08/01/2015 UI 07/13/2015 07/11/2015 ' $120.00
XXX-XX-4499 LORNE M BAXTER 08/01/2015 UI 07/20/2015 07/18/2015 $120.00
Total New Charges for Reporting Month 7/2015 $1,920.00
- - - - - - Total Amo int of Net Charges $1,920.00
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
II IIIIIIII 76524333 (1)
676277 90 -0629237
NEWPARENT
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
146500 Indiana Dept. of Workforce Development Terms
10 North Senate Ave., SEI 06 Date Due
Indianapolis, IN 46204-2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/3/15 676277 Benefit Charges Jul'15 36472 $ 1,920.00
Total $ 1,920.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with i C 5-11-10-1.6
20—
Clerk-Treasurer
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SEI 06
Indianapolis, IN 46204-2277
In Sum of$
$ 1,920.00
ON ACCOUNT OF APPROPRIATION FOR
101-General Fund
PO#or INVOICE NO. ACCT#/ AMOUNT Board Members
Dept# TITLE
36472 676277 4110000 $ 1,920.00 i hereby certify that the attached invoice(s), or
Pill(s)is(are)true and correct and that the
materials or services itemized thereon for
;which charge is made were ordered and
received except
August 6, 2015
i
Signature
$ 1,920.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund