186647 06/21/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
I CHECK AMOUNT: $7,030.57
CARMEL, INDIANA 46032 DEVELOPMENTATTN: ACCT RECV
oN dog. 101 N SENATE AVE CHECK NUMBER: 186647
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 6/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 164.82 OTHER EXPENSES
1125 4110000 151.91 FULL TIME REGULAR
1160 4110000 1,560.00 FULL TIME REGULAR
1192 4110000 2,476.36 FULL TIME REGULAR
1207 4111000 727.48 PART -TIME
601 5023990 1,950.00 OTHER EXPENSES
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Tall free 1 -800 -891 -6499 Marion County 232 -7436
STATEMENT OF BENEFIT CHARGES (FORM 535)
CONFIDENTIAL RECORO PURSUANT TO IC 22- 4 -19 -6, IC 4 66
Page 1
CITY OF CARREL ACCOUNT!
ATTN CLERK TREASURER LOCATION NUMBER 133438 000
ONE CIVIC SQ REPORTING MONTH MAY, 2010
CARREL IN 46032 -2584
NET CHARGES $7,030.57
POSTING DATE JUN -04, 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.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION I WEEK AMOUNT
NUMBER T EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO 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.
NEW CHARGES FOR THE REPORTING MONTH 05/10
R PADILLA 04/02/11 REG 05/17/10 05/15/10 ^mm 12.60
TOTAL NEW CHARGES FOR THE REPORTING MONTH 05/10 7,045.08
CONTINUE ON NEXT PAGE
An in the ACQ column denotes a charge resulting from an acquisition of another business.
Account/Location Number: 133438 000 Reporting Month, MAY, 2010 Page 2
Employer Name: CITY OF CAMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER I EMPLOYEE'S NAME DATE LEVEL I T DATE ENDING ACa CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 12/09
E E SWIRSKY C7 07/24/10 REG 05/19/10 12/05/09 kO. 03CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/09 10.03CR
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10/09
E E SWIRSKY �p 07/24/10 REG 05/19/10 10/17/09 J- 4 -48CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 10/09 4.48CR
TOTAL AMOUNT OF NET CHARGES 7,030.57
END OF BENEFIT CHARGE STATEMENT t
C r -7 .3
An in the ACC column denotes a charge resulting from an acquisition of another business.
Ic
VOOCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
Benefit Administration
IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$2,476.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1192 41- 100.00 $2,476.36 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, June 21, 2010
irector, D S
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
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))
05/31/10 Unemployment Rouse Devore, Pohl $2,476.36
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 Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$727.48
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 May 10 41- 110.00 $727.48 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, June 17, 2010
Director, Brooks 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 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))
06/10/10 May 10 Unemployment $727.48
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
VOUCHER 101939 WARRANT ALLOWED
k
1.46500 IN SUM OF
IN DEPT OF WORKFORCE DEVEL.
10 N. Senate Avenue, Ste 106
Indianapolis, IN 46204
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
0510 01- 4080 -12 $1,950.07
1-
Voucher Total $1,950.00
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
146500
IN DEPT OF WORKFORCE DEVEL. Purchase Order No.
10 N. Senate Avenue, Ste 106 Terms
Indianapolis, IN 46204 Due Date 6/17/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/17/2010 0510 $1,950.00
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
Date Officer
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 invoice(s) or bill(s)) PO Amount
614!10 133438 Benefit char a Ma '10
151.91
PAY ALILL, QF 101;'per M chael !!20108:, Vi'!'
Total 151.91
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.
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE 106
Indianapolis, IN 46204 -2277
In Sum of
151.91
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
1125 133438 4110000 151.91 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
17 -Jun 2010
Signature
151.91 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
4
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
IN SUM OF
Benefit Administration, 10 N. Senate Ave
Indianapolis, IN 46204 -2277
$1,560.00
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1160 3333438 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
Friday, June 18, 2010
t l4ayor
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))
06/04/10 1333438 $1,560.00
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