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HomeMy WebLinkAbout317764 10/25/2017 CITY OF CARMEL, INDIANA VENDOR: 146500 "" ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $""""" 118.88" ,? r� CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV CHECK NUMBER: 317764 10 N INDIANAPOLIS EE CHECK DATE: 10/25/17 IN46204-2277 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 R4110000 39329 676277 118.88 UNEMPLOYMENT CLAIMS « o -0 -0. 2 � $ 2 $ � O © 0 z q m > 2 K 7 q© CLo a R � A @ $ O 2 � # K w o E o E & q q , 2 $m 2 R -4 z & @ � ( k P k $ @ § iCL » 2 K E m » C $ ( U o j \ c 0 k ƒ o ■ / 0 C)CD M T CD ® / Amo OL \ >� \ p O $ ) 2 m 9 03 2 OD $ ] CD ] / a D Q / � m e o ® ::r - (D§ E & % a > m m -C� n o [ ( g ] \ § O " 2 « O 3 & cD \ T f \ \ k / g \ IQ $ \ § g 2 CD m c M N - W o Co E a & k �o 7 w / k 0. B » \ ƒ k ] o 0 0 r4 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT A. State Form 43191(R2/7-08),DWD 1067 10 N.SENATE AVE.SE 202 4a INDIANAPOLIS,N 46204-2277 CONFIDENTIAL RECORD PURSUANT TO IC 4-1-6,IC 22-4-19-6 0 010 6 7 D 11 10/02/2017 000261 CARMEL CLAY BOARD OF PARKS AND RECREATION REIMBURSABLE BILL 1411 E 116TH ST Account Number:676277 CARMEL IN 46032-3455 PAYMENT DUE DATE: 10/31/2017 AMOUNT DUE:$118.88 Please tear at line below and return top portion with your check or make payment at our website uplink.in.gov. If payment is made by check,please include your SUTA account number on the check. The following items apply to your benefit charges: ------------------------------------------es- ----------------- ----U------ ----Activity Summary Benefit Charges Interest Penalty Total Liability for Period --------------------------------------$------------------------------- 8/2017 Previous Balance $107.10 $0.00 $0.00 $0.00 8/2017 Assessment Of Interest/Penalty $0.00 $1.07 $10.71 $0.00 8/2017 Ending Balance $107.10 $1.07 $10.71 $118.88 Ending Balance: $118.88 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 10/31/2017. 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 RECEXVED OC 052017 i BY: I I 86156483 (1) 676277 90 - 0629237 -^4,. INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT I III II ILII VIII IIID VIII IIID ILII VIII IIID ILII ILII " �4. State Form 43283(R 17-08) (( m INDIANAPOLIS. SENATE AVE.SE 202 4.2 t�±�� INDIANAPOLIS.IN 46204.2277 4.1r� CONFIDENTIAL RECORD PURSUANT TO IC 4.1.6,IC 22.4.19.6 043283011 G _ .. link 08/01/2017 "^V° la1 — CARMEL CLAY BOARD OF PARKS AND RECREATION Account/Location 676277 1411 E 116TH ST Number CARMEL IN 46032-3455 Reporting Month 7/2017 Net Charges $107.10 Posting date 08/01/2017 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 Employee's Name Benefit Year Claim Transaction Paid for Acq Amount Charged security End Date Level Date Week Ending 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 7/2017"' XXX-XX-5990 DAVID B STOUT 05/05/2018 UI 07/31/2017 07/29/2017 $107.10 Total New Charges for Reporting Month 7/2017 $107.10 Total Amount of Net Charges $107.10 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 RECEIVED) OCT 2 3 2017 BY:. IIIIIIIIIIIIIIIIIIIIIIIIIIillllllllllllllllllllll 85561332 676277 90-0629237 (1)