183705 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
0 CARMEL, INDIANA 46032 DEVELOPMENT ATfN: ACCT RECV CHECK AMOUNT: $12,580.63
101 N SENATE AVE CHECK NUMBER: 183705
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1,950.00 OTHER EXPENSES
1120 4110000 1,560.00 FULL TIME REGULAR
1125 4110000 3,045.39 FULL TIME REGULAR
1192 4110000 3,120.00 FULL TIME REGULAR
1201 4110000 1,560.00 FULL TIME REGULAR
1207 4111000 846.00 PART -TIME
1125 R4110000 23052 499.24 UNEMPLOYMENT CLAIMS
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 1 D NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1 -900 -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
CARMEL IN 46032 -2584 REPORTING MONTH FEB, 2010
NET CHARGES $11,410.63
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 payments were made the employer had the opportunity
and the responsibility to report any information which could disqualify the claimant.
SOLI BENEFIT =ENDING
SECURITY YEAR END CLAIM RANSAGTION AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE CQ 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 (Form 1067) for these charges and any previous liability still outstanding.
NFU CHARGES FOR THE REPORTING MONTH 02/10
A MORELLI 09/04/10 REG 02/12/10 00 /00 /00 t„gttjun 159.24
D D JONES 02/27/10 REG 02/18/10 01 30 10 213.00
D D JONES 02/27/10 REG 02/18/10 02/06/10 213.00
D D JONES 02/27/10 REG 02/18/10 02/13/10 213.00
D D JONES 02/27/10 RE G 02/26/10 02/20/10 156.76
D D NORRIS 01/08/11 ,REG 02/02/10 01/23/10 390.00
D D NORRIS 01/08/11 REG 02/02/10 01 /30 /IRIAB ff� 390.00
D D NORRIS 01/08/11 REG 02/11/10 02/06/10 390.00
D D NORRIS 01/08/11 REG 02/16/10 02/13/10 390.00
D D NORRIS 01/08/11 REG 02/22/10 02/20/10 390.00
E M BROWN 1.7 Z8 10 REG 02/01/10 01 30,TI] Mt vu m 339.00
E M BROWN 12/18/10 REG 02/08/10 02/06/10 339.00
E M BROWN 12/18/10 REG 02/15/10 02/13/10 339.00
E M BROWN 12/18/ REG 02/22/10 02/20/10 339.00
E J N SPENCE 10/23/10 REG 02/07/10 02/06/10 112.94
I J N SPENCE 10/23/10 REG 02/14/10 02/13/10 168.00
J N SPENCE 10/23/10 REG 02/21/10 02/20/10 93.28
D M LINGELBAUGH 0 9T1 8710 REG 02 07 10 02 06 10 1 390.00
D M LINGELBAUGH 09/18/10 REG 02/14/10 02/13/10�� 390.00
D M LINGELBAUGH 09/18/10 REG 02/21/10 02/20/10 390.00
D M LINGELBAUGH 09/18/10 REG 02/28/10 02/27/10 390.00
K NEFOUSE 02/05/11 REG 02/22/10 02/20/10 1'\ 37.73
K NEFOUSE 02/05/11 REG 02/28/10 02/27/10 130.40
L B ROUSE DEVORE 12/25/10 REG 02/03/10 01/30/10 390.00
L B ROUSE- DEVORE 12/25/10 REG 02/08/10 02/06/10�L'�`1f 390.00
L B ROUSE DEVORE 12/25/10 REG 02/16/10 02/13/10 390.00
L B ROUSE-- DEVORE 12 25 10 REG 0 2/23/10 02/20/10 390.00
3 D E FRIESEN 1171 REG 02 1 7_ 10 02/06/10 c1 346.00
J L HOPE 08/14/10 REG 02/02/10 01/30/10 390.00
CONTINUE ON NEXT PAGE
An r) in the ACQ column denotes a charge resulting from an acquisition of another business.
Account/Location Number: 133438 000 Reporting Month: FEBRUARY, 2010 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT pglp FOH
SECURITY YEAR END CLAIM RANSAGTION WEEK ACQ AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING CHARGED
**R NEW CHARGES FOR THE REPORTING MONTH 02/10
J L HOPE 08/14/10 REG 02/09/10 02/06/10 fj 390.00
J L HOPE 08/14/10 REG 02/17/10 02/13/10 390.00
I J L HOPE T 08/ 14/10 REG 02/22/10 02 390.00
I E E SWIRSKY 07/24/10 REG 02/25/ _02 /06 3.28
D E TABELING 11 13/10 REG 02/01/10 01/30/10 125.00
D E TABELING 11/13/10 REG 02/07/10 02/06/10 r 125.00
D E TABELING 11/13/10 REG 02/15/10 02/13/10 125.00
D E TABELING 11/13/10 REG 02122/10 02/2_0/10 125.00
J M PENN 10 16 10 REG 02/01/30 _Ol/30 10 172.00
J M PENN 10/16/10 REG 02/08/10 02/06/10 172.00
J M PENN 10/16/10 REG 02/17/10 02/13/10 172.00
J M PENN 1 0/16/_1 0 R EG 0 2_/2 2/10 _02/20/10 172.00
B W,POHL 12 /18 /IQ REG O
Z /0 10
02/06/10 °tom 390.00
B W POHL 12/18/10 REG 02/15/10 02/13/10 390.00
B W POHL 12/18110 REG 02/22/10 02/20/10 390.00
B W POHL 12/18/10 REG 02/28/10 02/27/10 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 02/10 12,580.63
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 01 /10
J C GRIFFITHS 01 /01 /11 REG 02118/10 01/16/10 390.00CR
J C GRIFFITHS 01/01/11 REG 02/18/10 01/23/10 390.00CR
J C GRIFFITHS 01 /01 /11 REG 02/18/10 01/30/10 390.00CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 01/10 1,170.00CR
TOTAL AMOUNT OF NET CHARGES 11,410.63
The following charge(s) are POTENTIAL credits to your account. A determination was made and you were found not
liable for these charges. But because you have chosen to make payment in lieu of contributions for Unemployment
Insurance, your account cannot be credited for these charges unless or until the claimant(s) refund the overpayment.
Your account will be credited as the claimant refunds the overpayment in full or in monthly installments.
E E SWIRSKY 07/24/10 REG 12/26/09 105.26
of E E SWIRSKY 07/24/10 REG 02/06/10 3.26
END OF BENEFIT CHARGE STATEMENT
An in the ACQ column denotes a charge resulting from an acquisition of another business.
Monon ESE DOCS Mayor IS Golf Fire
159.24 213.00 390.00 390.00 390.00 346.00 390.00
339.00 213.00 390.00 390.00 390.00 125.00 390.00
339.00 213.00 390.00 390.00 390.00 125.00 390.00
339,00 156.76 390.00 390.00 390.00 125.00 390.00
339.00 112.94 390.00 390.00 125.00
37.73 168.00 390.00
130.40 93.28 390.00
3.28 172.00 390.00
172.00
172.00 G12,580,63 172.00
1,686.65 1,857.98 3,120.00 1,950.00 1,560.00 846.00 1,560.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
,N Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$846.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 133438- 00feb10 41- 110.00 $846.00 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
Thursday, March 25, 2010
Director, BrookshirWGolf 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))
03/07/10 133438- 00feb10 Unemployment $846.4
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
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 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
L j� j'� which charge is made were ordered and
received except
MAR 2 6 2010
1
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
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., SE 106 Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
317110. 133438 Benefit charge Feb'10 23052 F 499.24
317/10 133438 Benefit charge Feb'10 3,045.39
PAY3 nV,Q!jTR AT "'Oe,r Michael 11720408 '!k
Total 3,544.63
E 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
I
Voucher No. Warrant No.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE 106
Indianapolis, IN 46204 -2277
In Sum of
3,544.63
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
23052 F 133438 4110000 499.24 1 hereby certify that the attached invoice(s), or
1125 133438 4110000 3,045.39 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 -Mar 2010
Signature
3,544.63 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$3,120.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
1192 41- 100.00 $3,120.00 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
Thursday, March 25, 2010
Die
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts 1• 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))
03/25/10 Unemployment charges Bryan Pohi /Laura Rouse Devore $3,120.00
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