182685 03/02/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
q ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $11,916.22
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
101 N SENATE AVE CHECK NUMBER: 182685
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 3/2/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 3,120.00 OTHER EXPENSES
1120 4110000 1,560.00 FULL TIME REGULAR
1192 4110000 2,340.00 FULL TIME REGULAR
1207 4111000 500.00 PART -TIME
1202 R4110000 21687 632.31 UNEMPLOYMENT FEES
1125 R4110000 23052 3,763.91 UNEMPLOYMENT CLAIMS
13343$ -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1 -800 -891 -6499 Marion County 232 -7436
STATEMENT OF BENEFIT CHARGES (FORM 535)
CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -66
Page 1
CITY OF CARMEL ACCOUNT/
ATTN CLERK TREASURER LOCATION NUMBER 133438 000
ONE CIVIC SQ REPORTING MONTH JAN, 2010
CARMEL IN 46Q32 2584
NET CHARGES $11 ,916.22
POSTING DATE FEB-07, 2010
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
unemp'16yvneni Insur since, before an pa yments were made the e had the opportunity
and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME I DATE I LEVEL IT DATE ENDING A CHARGED
THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges
made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable
Bill (f=orm 1067) for these charges and any previous liability still outstanding.
NEW CHARGES FOR THE REPORTING MONTH 01 /10
Mi D D JONES 02/27/10 REG 01/20/10 01/16/10 w� 6 76.06 C
D D JONES 02/27/1.0 REG 01/26/10 01/23/10 LJ 213.00 J
A MOSIER 11/06/10 REG 01/03/10 01/02/10 218.00
i A MOSIER 11/06/10 REG 01 /11 /10 01/09/10 c� 218.00
t A MOSIER 11/06/10 REG 01/17/10 01/16/10 213.14
a S M CARY 07/03/10 REG 01/03/10 01/02/10 174.00
S M CARY 07/03/10 REG 01 /10 /10 01/09/10 X11,00 171.00 e5(
S M CARY 07/03/10 REG 01/17/10 01/16/10 32.00
E M BROWN 12/18/10 REG 01/08/10 01/02/10 339.00
7 E M BROWN 12/18/10 REG 01 111 /10 01/09/10 339.00
E M BROWN 12/18/10 REG 01/17/10 01/16/10 I�5(�.C� 339.00
E M BROWN 12/18/10 REG 01/25/10 01/23/10 339.00
tJ N SPENCE lu/ 23/ 10 F EE GI 03 /10 01/02/ 1
J N SPENCE 10/23/10 REG 01 /10 /10 01 /09 /10.9 ��n p 168.00
3.- J N SPENCE 10/23/10 REG 01/18/10 01/16/10 2L. I 13.90
J C GRIFFITHS 01 /01 /11 REG 01/25/10 01/16/10 390.00
A J C GRIFFITHS 01 /01 /11 REG 01/25/10 01/23/10 390.00
i J C GRIFFITHS 01 /01 /11 REG 01/31/10 01/30/10 390.00
i R K PE 07 03/10 REG O1 18 10 01/16/1 54.81 pytl
3 D M LINGELBAUGH 09/18/10 REG 01/03/10 01/02/10 390.00
D M LINGELBAUGH 09/18/10 REG 01 /10 /10 01/09/10 390.00
i D M LINGELBAUGH 09/18/10 REG 01/17/10 01/16/10 pp//',� 390.00 {ZL
D M LINGELBAUGH 09/18/10 REG 01/24/10 01/23/10 I"[� 390.00
D M LIN 09 _/18 /10 REG 0 1_/3 1 10 01/3 0/10 390.00
a L B ROUSE DEVORE 12/25/10 REG 01 /11 /10 01/09/10 390.00
1 L B ROUSE DEVORE 12/25/10 REG 01/19/10 01/16/10 390.00
I t L B ROUSE DEVORE _1_2 /25/10 RE G 01/25/10 01/23/1_0_ 390.00 l
mm G A FARSON 08/28/10 REG 01/19/10 10/17/09 47.35
ls 3 5 G A FARSON 08/28/10 REG 01/19/10 10/24/09 �3�.i 390.00 12
CONTINUE ON NEXT PAGE
k. in tF ACO column denotes a charge resulting from an acquisition of another business.
Account /Location Number: 133438 000 Reporting Month: JANUARY, 2010 Page 2
Employer Name; CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
NEW CHARGES FOR THE REPORTING MONTH 01 /10
G A FARS 08/28/10 REG 01/19/10 10/31/09 194.96
J�L HOPE 08/14/10 REG 01/05/10 01/02/10 390.00
J L HOPE 08/14/10 REG 01/12/10 01/09/10 390.00
J L HOPE 08/14/10 REG 01/20/10 01/16/10 390.00 1Z1
J L HOPE 08/14/10 REG 01/28/10 01/23/10 390.00
D E TABELING 11113710 REG 01/04/10 01/02/10 125.0
D E TABELING 11/13/10 REG 01/14/10 01/09/10 125.00
1 D E TABELING 11/13/10 REG 01/18/10 01/16/10 125.00 Z�
I D E TABELING 11/13/10 REG 01/24/10 01/23/10 125.00
J M PENN 10/16/10 REG 01/04/10 01/02/10 172.00
J M PENN 10/16/10 REG 01 /11 /10 01/09/10 f t�✓J 172.00
J M PENN 10/16/10 REG 01/18/10 01/16/10 172.00
J M PENN 10/16/10 REG 01/25/10 01/23/10 172.00
B W POHL 12/18/10 REG 01/17/10 01/16/10 390.00
B W POHL 12/18/10 REG 01/24/10 01/23/10 390.00
I B W POHL 12/18/10 REG 01/31/10 01/30/10 1 1`�O,dv 390.00
v
TOTAL NEW CHARGES FOR THE REPORTING MONTH 01 /10 11,916.22
TOTAL AMOUNT OF NET CHARGES 11,916.22
END OF BENEFIT CHARGE STATEMENT
CSC �n3,�
C�����r✓= h��o,vv
An in the ACQ column denotes a charge resulting from an acquisition of another business.
Prescribed by Slate Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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
1' bwt V v 1 `w r Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Ny
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
�o vq�
[Q 4 004
ON ACCOUNT OF APPROPRIATION FOR
Board Members
P09 or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), 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
7D I
12
D]
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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 invoices) or bill(s)) PO Amount
217110 133438 Benefit charge Jan'10 23052 3,763.91
f?A`(�ALL�OUT�O,F 10'1�,'�e��Mlchaei�1,112010 ti
Total 3,763.91
1 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�
4 Clerk- Treasurer
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE 106
Indianapolis, IN 46204 -2277
In S um of$
3,763.91
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT 111 AMOUNT Board Members
Dept TITLE
23052 133438 4110000 3,763.91 1 hereby certify that the attached invoice(s), or
L�f 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
25 -Feb 2010
Signature
3,763.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
.VOUCHER NO. WARRANT NO.
ALLOWED 20
IN Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$500.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 Jan2010 41- 110.00 $540.00 1 hereby certify that the attached invoice(s), 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
Friday, February 19, 2010
Director, Brookshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 199:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: Find 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,
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/31/10 Jan2010 Unemployment $500.0
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
VOUCHER NO. WARRANT NO.
Indiara Department of Workforce Development i ALLOWED 20
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
t
$2,340.00
1
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
i
t
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1192 41- 100.00 $2,340.00 1 hereby certify that the attached invoice(s), or
I
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
i
which charge is made were ordered and
received except
I
h sday February 25, 2010
Director, CS
I
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 {Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/07/10 Claims Bryan Pohl and Laura Rouse Devore $2,340.00
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
2Q
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204
$1,560.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 41- 100.00 $1,560.00 1 hereby certify that the attached invoice(s), 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
FEB 2 6 20
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
$1,560.00
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