HomeMy WebLinkAbout252919 1 2/29/1 5 "g"• CITY OF CARMEL, INDIANA VENDOR: 146500
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $*****1,559.90*
CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 252919
9yiTON�` 10 N SENATE AVE CHECK DATE: 12/29/15
INDIANAPOLIS IN 46204.2277
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 R4110000 37913 676277 1,559.90 UNEMPLOYMENT CLAIMS
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INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
State Form 43283(R/07-08)
10 N.SENATE AVE.
INDIANAPOLIS,IN 46204 02277
�erB c� CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6 043283011
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12/01/2015 unemplppmentprograms
DE"] 17 2015
779494911043283011 Set:8996 of 9464=�
CARMEL.CLAY BOARD OF PARKS AND RECREATION Account/Location 676277
1411 E 116TH ST Number
CARMEL IN 46032-3455 Reporting Month 11/2015
Net Charges $1,559.90
Posting date 12/01/2015
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 11/2015 **"
XXX-XX-' JEFFREY P KRAMER 04/16/2016 UI 11/01/2015 10/31/2015 $390.00
XXX-XX- JEFFREY P KRAMER 04/16/2016 UI 11/08/2015 11/07/2015 $390.00
XXX-XX- JEFFREY P KRAMER 04/16/2016 UI 11/15/2015 11/14/2015 $390.00
XXX-XX- JEFFREY P KRAMER 04/16/2016 UI 11/22/2015 11/21/2015 $389.90
Total New Charges for Reporting Month 11/2015 $1,559.90
Total Amount of Net Charges $1,559.90
An (") in the Acq column denotes a charge resulting from an acquired business.
- -sv1-arion—Courrty To11-Free-(800)-437-29'i 36-.
END OF BENEFIT CHARGE STATEMENT "
I II II II I IIIIIII IIII 77949491 (1)
676277 90 - 0629237
NEWPAHENT
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
12/1/15 676277 Unemployment charges Nov'15 37913 $ 1,559.90
Total $ 1,559.90
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
f
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE106
Indianapolis, IN 46204-2277
In Sum of$
$ 1,559.90
ON ACCOUNT OF APPROPRIATION FOR
101-General Fund
PO#or ACCT#/ I Board Members
Dept# INVOICE NO. TITLE AMOUNT i
37913 F 676277 4110000 $ 1,559.90 I hereby certify that the attached invoice(s), or
FINAL 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
December 17, 2015
Signature
$ 1,559.90 _ Accounts Payable Coordinator
..Qost distribution ledger classification if Title
claim paid motor vehicle highway fund