HomeMy WebLinkAboutIN Dept Workforce Dev 092917-tt4 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
State Form 43191 (R2 / 7-08), DWD 1067
AVE.10 N. SENATE
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4 easier, CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6, IC 22-4-19-6 001067011
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09/13/2017
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CITY OF CARMEL REIMBURSABLE BILL
ONE CIVIC SQ Account Number: 133438
CARMEL IN 46032-2584 PAYMENT DUE DATE: 9/30/2017
AMOUNT DUE: $1,670.48
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.
aThe following items apply to your benefit charges:
------------------------------------------------------------------------------------
Month/Year Activity Summary
Benefit Charges
Interest
Penalty
Total Liability for Period
------------------------------------------------------------------------------------
8/2017 Previous Balance
$0.00
$0.00
$0.00
$0.00
8/2017 Assessment of Benefit Charges
$1,713.77
$0.00
$0.00
$0.00
8/2017 Payment Adjustments
($43.29)
$0.00
$0.00
$0.00
8/2017 Ending Balance
$1,670.48
$0.00
$0.00
$1,670.48
Ending Balance: $1,670.48
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 add the collection agency's fee to your outstanding balance to
satisfy your account. If you fail to pay your tax debt and all collections 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 09/30/2017. 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
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Indiana Department of
Workforce Development
Online Payment Service
(http://www.in.gov/dwd/ )
Your transaction has been successfully completed.
Account Information
Payment Type: Employer Liability
Payments
Address: One Civic Square Carmel
IN 46032 US
Phone Number: 3145712428
Email Address:
dwalthall@carmel.in.gov
SUTA Account Number: 133438
Business Name: City of Carmel
FEIN: 35-6000972
Payment Information
Total Amount: $1670.48
Account Number:
Routing Number: 286371663
Account Type:
Commercial/Corporate
City of Carmel
One Civic Square Carmel IN 46032
US
Your confirmation number is:
7823665
09/29/2017 07:29:39 [CST]
https://www.payingov.com/Payment/Receipt 9/29/2017