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Home My WebLink About260075 06/28/16 y o•.cnxM CITY OF CARMEL, INDIANA VENDOR: 146500 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $*****1,288.05" s. CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 260075 9.y�TON � 10 N SENATE AVE CHECK DATE: 06/28/16 INDIANAbOLIS IN 46204.2277 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1701 4110000 06012016 1,288.05 FULL TIME REGULAR VOUCHER NO. WARRANT NO. l� 'D� ALLOWED 20 �cc�,�c•NCC . IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR'. Board Members P-o#-or—INVOICE-NO. CCT A #/T-IT-L-E AMOUNT erecerti 1-hb fy, att that-the- ached-invoice s DEPT.# Y 'Y ( )� 1100 060 1 1016 A\\0000 1111$.b5 or 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 G y" 20 ignat re C Ti e Cost distribution ledger classification if claim paid motor vehicle highway fund INDIANA DEPARTMENT OF WORKFORCE'DEVELOPMEN7 4 State Form 43283(R/7-08) 10 N.SENATE AVE.SE INDIANAPOLIS,N 46204-2277 CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4.19-6 043283011 +ore 06,01/2016 � v1. il �K\ Geo Ink oymenfprogramsp I-ek unempl 805146501043283011 Set:3085 of 9902 CITY OF CARMEL Account/Location 133438 ONE CIVIC SQ Number CARMEL IN 46032-2584 Reporting Month 5/2016 Net Charges $3,475.00 Posting date 06/01/2016 p�.. 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 oppor unity 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 5/2016 '"" XXX-XX-4449 LOIS A CRAIG 12/24/2016 UI 05/01/2016 04/30/2016 $390.00 XXX-XX-4449 LOIS A CRAIG 12/24/2016 UI 05/08/2016 05/07/2016 $390.00 XXX-XX-4449 LOIS A CRAIG 12/24/2016 UI 05/15/2016 05/14/20116 $390.00 XXX-XX-4449 LOIS A CRAIG 12/24/2016 UI 05/23/2016 05/21/2016 $390.00 XXX-XX-4449 LOIS A CRAIG 12/24/2016 UI 05/29/2016 05/28/2016 $390.00 XXX-XX-1677 SANDRA M JOHNSON 04/22/2017 UI 05/12/2016 05/07/2016 $390.00 XXX-XX-1677 SANDRA M JOHNSON 04/22/2017 UI 05/16/2016 05/14/2016 $390.00 XXX-XX-1677 SANDRA M JOHNSON 04/22/2017 UI 05/22/2016 05/21/2016 $390.00 XXX-XX-1677 SANDRA M JOHNSON 04/22/2017 UI 05/30/2016 05/28/2016 $390.00 —Total New-Charges-for Reporting Month 5/2-01-6-__'_____$3,510.00 Reversed charges for the prior month 9/2011 *** XXX-XX-5760 GREG A PARK 02/18/2012 UI 05/12/2016 09/24/2011 $35.00CR Total Reversed Charges/Credits for the Prior Month 9/2011 $35.00CR Total Amount of Net Charges $3,475.00 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 80514650 (1) 133438 35_60I]I7972 NEWPARENT INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT State Form 43191(R2/7.08),DWD 1067 �0 10 N.SENATE AVE.SE 202 INDIANAPOLIS,IN 46204-2277 CONFIDENTIAL RECORD PURSUANT TO IC 4-1.6,IC 22-4-19-6 001067011 06/01/2016 Grmo i n k unemployment programs 805111891001067011 Set:464 of 1137 CITY OF CARMEL REIMBURSABLE BILL ONE CIVIC SQ Account Number: 133438 CARMEL IN 46032-2584 PAYMENT DUE DATE:6/30/2016 AMOUNT DUE:$1,288.05 Please tear at line below and return top portion with your check or make payment at our website uplink.in.gov. If payment is made by check,please include your SUTA account number on the check. �e The following items apply to your benefit charges: ------------------------------------------------------------------------------------------------------------------------------------- Month/Year --ActivitySummaryBenefit Chargesi Interest Penalty Total Liability for Period - ---------------------- ------------------------------------------------------------------•--------------------------------- 5/2016 Previous Balance $0.00 $0.00 $0.00 $0.00 a 5/2016 Assessment of Benefit Charges _$1,560.00 $0.00- $0.00 -- $0.00- 5/2016 0.00-5/2016 Payment Adjustments ($271.95) $0.00 $0.00 $0.00 5/2016 Ending Balance $1,288.05 $0.00 $0.00 $1,288.05 Ending Balance: $1,288.05 If the Department has referred your account to a collection agency, please note that the total amount set forth on this notice does not include the collection agency's fee.-Please a d the collection agency's fee to your outstanding balance to satisfy your account. If you fail to pay your tax debt and all co lections fees in full,the Department may assess additional interest and penalties. This is your total liability. Payment mailed after the 20th of the month may not be reflected on this bill. Please pay this amount no later than 06/30/2016. Additional interest will accrue at a rate of 1%per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If you have any questions, please call (800) 437-9136 and ask for a Collection representative 817511189 (1) 133438 35- 600972