HomeMy WebLinkAbout194927 02/28/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $5,873.09
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
101 N SENATE AVE
CHECK NUMBER: 194927
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 2/28/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 969.54 UNEMPLOYMENT
1192 4110000 390.00 FULL TIME REGULAR
1125 R4110000 28036 4,513.55 UNEMPLOYMENT FEES
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1- 800.891.6499 Marion County 232.7436
STATEMENT OF BENEFIT CHARGES (FORD 535)
CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -66
Page 1
CITY OF CARMEL y
ATTN CLERK TREASURER D V LOCA 133438 000
ONE CIVIC SQ REPORTING MONTH JAN, 2011
CARMEL IN 46032 2584 FEB 17 2011
NET CHARGES $5,873.09
POSTING DATE FEB 2011
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 PA1D FOR
SECURITY YEAR END CLAIM FRANSACTICIN WEEK AMOUNT
NUMBER EMPLOYEE'S NAME I DATE LEVEL DATE ENDING ACn CHARGED
THIS IS NOT A RILL 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 01 /11
T A WEDDINGTON 12/31/11 REG 01/30/11 01/15/11} l� 390.00
1 l
TOTAL NEW CHARGES FOR THE REPORTING MONTH 01/11 5,873.09
TOTAL AMOUNT OF NET CHARGES 5,873.09
An in the ACQ column denbtesUehCjg� I'fi i ��GWMUW 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
217111 133438 Benefit charge Jan'11 28036 4,513.55
Total 4,513.55
i hereby certify that the attached invoice(s), or bil(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
4,513.55
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
28036 133438 4110000 4,513.55 1 hereby certify that the attached invoice(s), or
bi•.I(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
24 -Feb 2011
Signature
4,513.55 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Department of Workforce Development
Benefit Administration IN SUM OF
10 North Senate Avenue
Indianapolis, IN 46204 -2277
$390.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO Dept, INVOICE NO. ACCT /TITLE AMOUNT Board Members
1192 41 -100.00 $390.00
I hereby certify that the attached invoice(s), or
I f
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, Febru y 28, 2011
Director, DO
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))
02/06/11 Unemployment Trudy $390.00
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
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.
Payee
J U r yyy Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
nlY rut
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.
ALLOWED 20
CCU" n IN SUM OF
Z
T'
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�LZ e� �,o IDdU bill(s) is (are) true and correct and that the
4 DC IC) materials or services itemized thereon for
which charge is made were ordered and
received except
A. a
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund