HomeMy WebLinkAbout183706 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
CHECK AMOUNT: $235.10
CARMEL, INDIANA 46032 DEVELOPMENTATTN: ACCT RECV
101 N SENATE AVE CHECK NUMBER: 183706
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4110000 GOLF 235.10 FULL TIME REGULAR
567041 -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
BLOCKOMS GOLF MANAGEMENT COMPANY L L C ACCOUNT/
12120 BROOKSHIRE PKWY LOCATION NUMBER 567041 000
CARMEL IN 46033 -3314 REPORTING MONTH FEB, 2010
NETCHARGES $235.10
POSTING DATE MAR 07, 2010
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
unemployment insurance since, before any pnyments .were madc- the employer had the opportunity
and the responsibility to report any information which could disqualify the claimant,
SOCIAL i BENEFIT PAID FOR
SECURITY YEAR END I CLAIM W EEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING A CHARGED
NEW CHARGES FOR THE REPORTING MONTH 02/10
M A MONTGOMERY 08/14/10 'REG 02/24/10 02/20/10 235.10
TOTAL NEW CHARGES FOR THE REPORTING MONTH 02/10 235.10
TOTAL AMOUNT OF NET CHARGES 235.10
END OF BENEFIT CHARGE STATEMENT
An in the ACO column denotes a charge resulting from an acquisition of another business.
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN Department of Workforce Development
Benefit Administration
IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$235.10
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO, ACCT #ITITLE AMOUNT Board Members
1207 567041- 41- 100.00 $235.10 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
Monday, March 15, 2010
a�id A
Director, Brook ire 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: 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))
02/28/10 567041- OOOFEBI Unemployment $235.1
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
Clerk- Treasurer