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Home My WebLink About191083 10/26/2010 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 e ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CARMEL, INDIANA 46032 DEVELOPMENT ATTN ACCT RECV CHECK AMOUNT: $1,719.17 101 N SENATE AVE CHECK NUMBER: 191083 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 10/26/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 196.39 UNEMPLOYMENT 1125 4110000 1,132.78 FULL TIME REGULAR 1301 4110000 390.00 FULL TIME REGULAR 13343.8 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDfANAPOLIS, 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 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC 5 4 CARMEL IN 46 ©32- -2584 a REPORTING MONTH SEP, 2010 ��jj ET CHARGES $1, 719. 17 OSTING DATE OCT 2010 The receipt of this statement (Form 535) dods•nQt reopen the question of the claimant's eligibility for unemployment insurance since, before any pay me�tts..Vy,Pre made the employer had the opportunity and the responsibility to report any.information which could disqualify the claimant. SCCIAL 6ENcFiT IAIQ FOR SECURITY YEAR END 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 end of the "posting" month, you will receive a Reimbursable Bill (Farm 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 09/10 L M BREWER 12/12/09 EB 09 /30/10 09/25/10 16.36 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: SEPTEMBER, 2 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING AC© CHARGED NEW CHARGES TOR THE REPORTING MONTH 09/10 TOTAL NEW CHARGES FOR THE REPORTING MONTH 09/10 1,719.17 TOTAL AMOUNT OF NET CHARGES 1,719.17 END OF BENEFIT CHARGE STATEMENT An in the ACQ column denotes a charge resulting 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., SE 106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 1011110 133438 Benefit charge Sep'10 1,132.78 PRY ALL;OUT OF 101 jperMi6hae1,;11)20 /08 Total 1,132.78 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. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of 1,132.78 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 1,132.78 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 25 -Oct 2010 Signature 1,132.78 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund