HomeMy WebLinkAbout249568 09/23/15 "u CITY OF CARMEL, INDIANA VENDOR: 146500
® ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $*****1,950.00•
CARMEL, INDIANA 46032 DEN SENATE AVE
ACCT RECV CHECK NUMBER: 249568
10 INDIANAPOLIS IN 46204-2277 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 R4110000 37913 676277 1,950.00 UNEMPLOYMENT CLAIMS
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
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State Form
83(07-
10 SENATE 202
INDIANAPOLIS,IN 46204-2277
CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6 043283011
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09/02/2015 P
ployment Pm9rams
SE.P 0 8 2015
769166171043283011 Set:8989 of 9384 Br 1 - —_ I
CARMEL CLAY BOARD OF.PARKS AND RECREATION Account/Location 676277
1411 E 116TH ST Number
CARMEL IN 46032-3455 Reporting Month 8/2015
Net Charges $1,950.00
Posting date 09/02/2015
STATEMENT OF BENEFIT CHARGES
CONFIDENTIAL RECORDS PURSUANT TO IC 22-4-19-6, 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 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 8/2015"
JEFFREY P KRAMER 04/16/2016 UI 08/30/2015 08/29/2015 $390.00
Total New Charges for Reporting Month 8/2015. : $1,950.00
Total Amount of Net Charges $1,950.00
An"C) in;th 6 Acq column denotes-a charge`resuiting from'an--a-uquirecrb—sines.
Marion County Toll Free (80.0) 437-9136.
END OF BENEFIT CHARGE STATEMENT
IIIIIII 76916617 (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., SE106 Date Due
Indianapolis, IN 46204-2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
9/2/15 676277 Benefit Charges Aug'15 37913 $ 1,950.00
Total $ 1,950.00
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
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE106
Indianapolis, IN 46204-2277 f
In Sum of$
$ 1,950.00 l
ON ACCOUNT OF APPROPRIATION FOR I
101-General Fund
l
PO#or INVOICE NO. ACCT#/ AMOUNT , Board Members
Dept# TITLE
37913 676277 4110000 $ 1,950.00 I;ii(hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
hich charge is made were ordered and
r1ceived except
I
I
September 17,2015
Signature
$ 1,950.00 1 Accounts Payable Coordinator
Cost distribution ledger classification if j Title
f claim paid motor vehicle highway fund 4I
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