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Home My WebLink AboutIN Dept Workforce Dev 08222017E «TTa INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT State Form 43283 (R / 7-08) 10 N. SENATE AVE. SE INDIANAPOLIS, IN 46204-2277 ^; 043283011 CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6, IC 22-4-19 6 00 link 07/03/2017 1, ...,,,. >1..1,,, CITY OF CARMEL ONE CIVIC SQ CARMEL IN 46032-2584 003641 Account/Location 133438 Number Reporting Month 6/2017 Net Charges $1,643.00 Posting date 07/03/2017 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 6/2017 *** XXX -XX- 0085 RICHARD P PIFER 02/03/2018 UI 06/07/2017 05/27/2017 $390.00 XXX -XX- 0085 ` RICHARD P PIFER 02/03/2018 UI 06/06/2017 06/03/2017 $390.00 XXX -XX- 0085 RICHARD P PIFER 02/03/2018 UI 06/12/2017 06/10/2017 $390.00 XXX -XX- 0085 RICHARD P PIFER 02/03/2018 UI 06/20/2017 06/17/2017 $390.00 XXX -XX- 0085 RICHARD P PIFER 02/03/2018 UI 06/27/2017 06/24/2017 $390.00 Total New Charges for Reporting Month 6/2017 $1,950.00 *** Reversed charges for the prior month 4/2012 *** XXX -XX- 5760 GREG A PARK 02/18/2012 Ul 06/05/2017 02/18/2012 $146.000R XXX -XX- 5760 GREG A PARK 02/18/2012 UI 06/14/2017 02/18/2012 $37.000R Total Reversed Charges/Credits for the Prior Month 4/2012 $183.000R *** Reversed charges for the prior month 10/2011 *** XXX -XX- 5760 GREG A PARK 02/18/2012 UI 06/05/2017 10/01/2011 $124.000R Total Reversed Charges/Credits for the Prior Month 10/2011 $124.00CR Total Amount of Net Charges $1,643.00 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 ** 1111111111111111111111111111111111111111111111111 8=2=2777 133438 35-6000972 (1) Good Morning Dianne INDIANA is DEVELOPMENT Account # Horne - LJ 133438 select Employer 133438 SeledCEmployer Account 133438 ► Summary Information ► File Reports Make Payments _. Thursday, July 27, 2017 t# Hit I Contact I Resources I Luff oo link Legal Name Due Type Period Type Period/Year Total Due Payffmat Armmt CITY Of CARMEL UI Tax monthiv 712017 $1,950.00 1950.0 CITY OF CAPNEL UI Tax Mon:hly 5/2017 $1,999.87 1999,87 CITY OF CARMEL UI Tax Monthly 312017 $50.00 50,00 -- ► Profile Maintenance How do you wish to pay?;Certain ► Submit a Request may a Change Account Status My Documents Employer Rate Calculator P Maintain Users Multi Claimant Group Total Payment: $ 2049.87 i *y; When paying by check, please utilize print function anti include printout with remittance. Cancel Online Payment Service by VPS I 1 WQRIVt)IAh'A KFQRCE 1)1.VF.1.OPA1[1KT Page 1 of 1 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: 3175712414 Email Address: dswalthall@carmel.in.gov SUTA Account Number: 133438 Business Name: City of Carmel FEIN:356000972 Payment Information Total Amount: $1950.00 Account Number: Routing Number: 286371663 Account Type: Personal Checking City of Carmel One Civic Square Carmel IN 46032 US Your confirmation number is: 7951845 08/22/2017 11:38:47 [CST] https://www.payingov.com/Payment/Receipt 8/22/2017 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT State Form 43191 (R2 / 7-08), DWD 1067 4, 10 N. SENATE AVE. SE 202 INDIANAPOLIS, IN 46204-2277 CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6, IC 22-4-19-6 001067011 Zink 08/01/2017 °' ' 111 is CITY OF CARMEL ONE CIVIC SO CARMEL IN 46032-2584 REIMBURSABLE BILL Account Number: 133438 PAYMENT DUE DATE: 8/31/2017 AMOUNT DUE: $4,219.86 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. '�t z The following items apply to your benefit charges: ------------------------------------------s- Month/Year Activity Summary Benefit Charges -1 ------------------------------------ Interest Penalty Total Liability for Period ------------------------------------------------------------------------------------ 3/2017 Previous Balance $0.00 $0.00 $0.00 $0.00 3/2017 Adjustments Of Interest/Penalty $0.00 $0.00 $50.00 $0.00 3/2017 Ending Balance $0.00 $0.00 $50.00 $50.00 ------------------------------------------------------------------------------------ Month/Year Activity Summary Benefit Charges Interest Penalty Total Liability for Period 6/2017 Previous Balance $1,999.87 $0.00 $0.00 $0.00 6/2017 Assessment Of Interest/Penalty $0.00 $20.00 $199.99 $0.00 6/2017 Ending Balance $1,999.87 $20.00 $199.99 $2,219.86 ------------------------------------------------------------------------------------ Month/Year Activity Summary Benefit Charges Interest Penalty Total Liability for Period $ s 7/2017 Previous Balance $0.00 $0.00 $0.00 $0.00 7/2017 Assessment of Benefit Charges $1,950.00 $0.00 $0.00 $0.00 0 7/2017 Ending Balance $1,950.00 $0.00 $0.00 $1,950.00 Ending Balance: $4,219.86 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 08/31/2017. 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 Received Carmel Clerk -Treasurer <Zly I)--) „=,e=o. - 35-6000972 ,,, .3Eai"k783 %BBI