HomeMy WebLinkAbout251433 11/17/15 / CITY OF CARMEL, INDIANA VENDOR: 146500
is ® ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $*****1,560.00*
i� CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 251433
y�*oN 10 N SENATE AVE CHECK DATE: 11/17/15
INDIANAPOLIS IN 46204-2277
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION'
1125 R4110000 37913 676277 1,560.00 UNEMPLOYMENT CLAIMS
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
State Form 43283(R/07-08)
Z
� fe 10 N.SENATE AVE.SE 202
'. INDIANAPOLIS,JN 46204-2277 043283011
's CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6
16
RECEIVED woonamlink
15
11/02/2015
NOV _ A ^O ploymem programs
775741271043283011 Set:300 of 8813 BY:
CARMEL CLAY BOARD OF PARKS AND RECREATION Account/Location 676277
1411 E 116TH ST Number
CARMEL IN 46032-3455 Reporting Month 10/2015
Net Charges 1$1,560.00
Posting date 11/02/2015
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
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 10/2015
JEFFREY P KRAMER 04/16/2016 UI 10/25/2015 10/24/2015 $390.00
Total New Charges for Reporting Month 10/2015 $1,560.00
Total Amount of Net Charges $1,560.00
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**
III 77574127 (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
11/2/15 676277 Benefit Charges Oct'15 37913 $ 1,560.00
Total $ 1,560.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
120
Clerk-Treasurer
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE106
Indianapolis, IN 46204-2277
jn Sum of$
I
$ 1,560.00
ON ACCOUNT OF APPROPRIATION FOR
101-General Fund
PO#or INVOICE NO.' ACCT#/ AMOUNT Board Members
Dept# TITLE
37913 676277 4110000 $ 1,560.00 1 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
November 6, 2015
Signature
$ 1,560.00 i, Accounts Payable Coordinator.
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
e'