HomeMy WebLinkAbout186579 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1
o ONE CIVIC SQUARE INDIANA STATE CENTRAL COLLECTIOIEHECK AMOUNT: $110.00
z` CARMEL, INDIANA 46032 UNITASFE
PO BOX 6271 CHECK NUMBER: 186579
INDIANAPOLIS IN 46206-6271
CHECK DATE: 6!912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 110.00 CHILD SUPPORT FEES
_5
THE EMPLOYEES LISTED BELOW OWE THE 2010 INDIANA ANNUAL SUPPORT FEE.
The remittance for the Annual Support Fee must be mailed separately to the special ASFE PO Box address listed
1 below.
If one or more of the persons listed are no longer employed or have never been employed by your company, that
information can be mailed with the payment or faxed to 317- 234 -4767.
Retain a copy for your records and /or to send with additional payments
in case multiple payments are necessary to pay the entire amount due.
Employer Name: CITY OF CARMEL Make Check payable to:
sDBA: INSCCU —.ASFE
FEIN: 356000972 PO Box 6271
Indianapolis IN 46206 -6271
Employee's Name Employee's Pate of Last. Case# Amount Amount
SSN Day:Worked Due PayEng
or per.case per case
mm
Never
Empigyea
CARTER, MARCUS L. XXX -XX -
ASFE4264660 $55.00
Order to Withhold Income
for the 2010 Indiana Annual Support Fee
Indiana Department of Child Services
State Child Support Bureau
Per Indiana Statutes IC- 33- 37 -5 -6 and IC- 31 -16 -15
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#9781 9996 43R# 6/4/2010
CITY OF CARMEL
ONE CIVIC SQUARE
ATTN KAREN HUFFMAN
CARMEL IN 46032
This is an Order to Withhold Income for the 2010 Annual SLIpport Fee. This fee is charged to non custodial parents
pursuant to Indiana statute. You are required by law, IC- 33- 37 -5 -6 and IC 31- 16 -15, to deduct these amounts from the
employee's income. The deduction should be made from the next payroll, or as soon thereafter as practical and
forwarded to the Indiana State Central Collection Unit (INSCCU). This deduction is in addition to any other child
support or support- related payments you may be deducting.
Special payment instructions:
This is a once a year fee deduction that should be made AFTER all other child support payments are
deducted. If the maximum percentage for child support is met every pay period, you cannot withhold the fee
(see CCPA information below).
Even if you are not currently withholding child support for this employee, the fee still needs to be withheld.
Please complete the list on the reverse of this letter and send it with payment to address listed on the reverse.
A copy of this list MUST accompany the payment.
A separate check is required for this fee; do not combine the fee with regular child support payments.
Please note that the P.O. Box for fee payments is different than for regular child support payments_
The Annual Support Fees withheld from all employees listed should be combined in a single fee payment
check, if possible.
This Fee CANNOT be made by Electronic Funds Transfer (EFT) or by Electronic Data Interchange (EDI).
Only regular child support payments can be paid by EFT /EDI, not fees.
However, for your convenience, you may have the fee debited from your Bank Account by using the Child
Support Bureau's Employer Online Payment System, ASFE section. For more information concerning this
process, please call 317- 232 -0327 or 1 -800- 292 -0403, option 1.
You may retain a two dollar ($2.00) fee from the non custodial parent's income for this income withholding.
Consumer Credit Protection Act (CCPA): Federal law requires states to limit the amount which can be collected by
income withholding to 60% of disposable earnings per pay period, or 50% of disposable earnings if your employee is
supporting another spouse or dependent child (current family). If earnings are not sufficient to make the full
payment (which may include the $2.00 fee), partial deductions should be made up to the CCPA limit.
If you have any questions, please contact the Child Support Bureau, EMPLOYER MAINTENANCE UNIT (EMU) at
317 232 -0327 or 1- 800 -292 -0403 or EMUC@DCS.IN.pov
C. _f_ag.VT�
6
Cynthia Longest.
Deputy Director
Department of Child Services
Child Support Bureau
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
Pa
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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.
(1 ALLOWED 20
I IC
IN SUM OF
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ON ACCOUNT OF APPROPRIATION FOR
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PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Ibi TV 50 I Q 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
AA 20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund