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Home My WebLink About197465 05/19/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $9,963.02 CARMEL, INDIANA 46032 DEVELOPMENT ATM ACCT RECV 101 N SENATE AVE CHECK NUMBER: 197465 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 5/19/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4110000 1,560.00 FULL TIME REGULAR 1120 4110000 2,730.00 FULL TIME REGULAR 1125 4110000 4,289.02 FULL TIME REGULAR 1192 4110000 1,170.00 FULL TIME REGULAR 1207 4110000 214.00 FULL TIME REGULAR 133438 -1 INDIANA DEPARTMENT OF WORKFORCE.DEVELOPM €NT 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 RECORD PURSUANT TO IC 22- 4- 1:8 -6, IC 4 -1 -66 Page 1 CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 --000 ONE CIVIC SQ REPORTING, MONTH APR, 2011 CARMEL IN 46032- 258 >4 NET CHARGES $.9,,963.02 P05TING DL1TE MAY 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 since,,. before vrhich could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT NUMBER 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 04/11 J L HOPE 08/14/10 EB 04/06/11 04/02/11 390.00 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: APRIL, 201.1 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END GLA1M TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE L) VEL DATE ENDING ACO CHARGED NEW CHARGES FOR THE REPORTING MONTH 04/11 J M PENN 10/16/10 EB 04/26/11 04/23/11 172.00 TOTAL. NEW CHARGES. FOR THE REPORTING MONTH 04/11 9,963.02 TOTAL AMOUNT OF NET CHARGES 9,963.02 The following charge(s) are PCTENTfAL credits to your account. A.determination'was made and you were found not liable for these charges. But because you h6ve;chose:n:to make payment in..lieu of contributions for Unemployment Insurance, your account cannot be credited °these charges unless or until the claimant(s) refund the overpayment. Your account will be credited' as the claimant refunds the overpayment in full or in monthly installments. 307 063124 J N SPENCE 10/23/10 EB 01/22/11 86.40 307 -06 -3124 J N SPENCE 10/23/10 EB 01/29/11 79.55 307 -06 -3124 J N SPENCE 10 /23/10 EB 02/05/11 115.21 307 -06 -3124 J N SPENCE 10/23/10 EB 02/12/11 115.21 307-06-3124 J.N SPENCE 10/23/40 EB 02/19/11 115.21 307 -06 -3124 J N SPENCE 10/23/10 EB 02/26/11 115.21 END OF BENEFIT CHARGE STATEMENT Vov 0� .v 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., SE106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 516111 133438 Unemployment charges Apr'11 4,289.02 Total 4,289.02 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., SE106 Indianapolis, IN 46204 -2277 In Sum of 4,289.02 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 4,289.02 f 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 -May 2011 Signature 4,289.02 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 $214.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO## Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1207 133438 41- 110.00 $214.00 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 Wednesday, May 18, 2011 Director, Brookshir 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. 199`. 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 HAHIUUNL Date Number (or note attached invoice(s) or bill(s)) 05/06/11 133438 Unemployment $214.0 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. ALLOWED 20 Indiana Department of Workforce Development Benefit Administration IN SUM OF 10 North Senate Avenue Indianapolis, IN 46204 -2277 $1,170.00 ON ACCOUNT OF APPROPRIATION FOR 1 Carmel DOCS PO# 1 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members T 119 I 41- 100.00 I $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 i I' Thursday, May 19, 2011 rector 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)) 05/18/11 Unemployment -Trudy $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 Proscribed 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 0 L m 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. ALLOWED 20 uo _ice pu ra-- u- IN SUM OF q ON ACCOUNT OF APPROPRIATION FOR (,tL b&)(nj Board Members Pp# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or lam �A J ,C) J) ?.bill(s) is (are) true and correct and that the G` q vD t materials or services itemized thereon for which charge is made were ordered and U received except l i Ali w v 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund