189220 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
1J ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $5,793.11
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
4 off `0 101 N SENATE AVE CHECK NUMBER: 189220
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4110000 1,644.23 FULL TIME REGULAR
1160 4110000 1,170.00 FULL TIME REGULAR
1192 4110000 780.00 FULL TIME REGULAR
1207 4111000 638.88 PART -TIME
601 5023990 1,560.00 OTHER EXPENSES
133438 -1
c,
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT E�
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS; IN .46204 =2277
Tall free 1- 600 -891 -6499 Marion County 232 -7436 1 1 7 201 �gd�
STATEMENT OF BENEFIT CHARGES (FORM 535)
CONFIDENTIAL RECORD PURSUANT TOIC 22- 4 -19 -6, IC 4 -1 -66, By
age 1
CITY OF CARMEL ACCOUNT/
ATTN CLERK TREASURER LOCATION NUM 133438 000
ONE CIVIC SQ REPORTING MONTH JUL, 2010
CARMEL IN 46032 2584
NET CHARGES $5,7
POSTING DATE AU7G 2:010
The receipt of this statement (Form 535) does not reopen the question of the cla imant'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 O
SECURITY YEAREND CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL„ DATE ENDING ACQ 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 'endof the "posting "month „you will receive R eimbursable
Bill (Form 1067) for these charges and any previous liability still outstanding.
NEW CHARGES FOR THE REPORTING MONTH 07/10
C MURRAY 06/04/1.1 REG 07/26/10 07/24/10 5.63
TOTAL NEW CHARGES FOR THE REPORTING MONTH 07/10
CONTINUE ON NEXT PAGE
An in the ACQ column denotes a charge resuiting from an acquisition of another. business.
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
814110 133438 Benefit charge Jul'10 1,644.23
PAYALL,' F
Q101'� erMichael "11120108
OU 't
Total 1,644.23
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 No. Warrant No,
146500 Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE 106
Indianapolis, IN 46204 -2277
In Sum of
1,644.23
ON ACCOUNT OF APPROPRIATION FOR
101 Genera! Fund
P0# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
1125 133438 4110000 1,644.23 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
FG R N E E- K materials or services itemized thereon for
which charge is made were ordered and
O-A r� t�y I S received except
l
17 -Aug 2010
Signature
1,644.23 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
$638.88
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. !4:1-:110.00 CT #!TITLE AMOUNT Board Members
1207 133438 -000 7 -10 $638.88 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
Tuesday, August 17, 2010
7,n d Y,
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. 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))
08/04/10 133438 -000 7 -10 Unemployment $638.88
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
Prescribed by State Board of Accounts
F 3 0' cBev.,sss, ACCOUNTS PAYABLE VOUCHER
TO
ADDRESS
Invoice Date Invoice Number Item 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
19
Signature Title
I hereby certify that the attached invoice(s), or bill(s), is (are) true and wrrect and I have audited same in accordance
with IC 5- 11- 10-1.6.
i9
fficer Title
i
Voylcher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ACCT.
NO.
CARMEL, INDIANA
Fav
Total Amount of Voucher
Deductions
7 10 5 6
Amount of Warrant
Month of 19
Acct.
VOUCHER RECORD IN
Source of Suppl
Water Treatment
Transmission and Dist.
Customer Accounts
Administrative and General 7
Operation Maintenance
Utility Plant in Service
Constr. Work in Progress
Materials and Supplies
Customers Deposits
1 l
Total
Allowed
I
Board of Control
Filed
Official Title
BOYCE FORMS SYSTEMS 1- 800- 382- 8702 225
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$780.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
1192 41- 100.00 $780.00 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, August 27, 2010
irector,. 1 25i I ES
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 inv oice(s) o r bil
07/31/10 Laura Rouse Devore unemployment $780.00
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
IN SUM OF$
Benefit Administration, 10 N. Senate Ave
Indianapolis, IN 46204 -2277
$1,170.00
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT #(TITLE AMOUNT Board Members
1160 133438 41- 100.00 $1,170.00 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
Tuesday, August 17, 2010
A ayor
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))
08/04/10 133438 $1,170.00
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