159676 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: 361282 Page 1 of 1
h 0 e ONE CIVIC SQUARE WORKER TRAINING FUND CHECK AMOUNT: $115.90
CARMEL, INDIANA 46032 P 0 BOX 6285
INDPLS IN 46206 -6285 CHECK NUMBER: 159676
CHECK DATE: 5/14/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4347500 567041 115.90 GENERAL INSURANCE
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INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
WORKER TRAINING ASSESSMENT (FORM 1215)
CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -6
Additional interest will accrue at a rate of 1% per month and a one time penalty of $25.00 will be assessed on any
outstanding balances after the payment due date.
If you have any questions, please call (800) 891 -6499 or (317) 232 -7436.
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BLOCKOMS GOLF MANAGEMENT COMPANY L L C PAGE: 1 OF 1
12120 BROOKSHIRE PKWY
CARMEL IN 46033 -3314
As sessment posted for 2008; Calculated
using 2007 taxable wages ACCOUNT NUMBER: 567041
ACTIVITY SUMMARY ASSESSMENT INTEREST PENALTY TOTAL LIABILITY
FOR THE PERIOD
PREVIOUS BALANCE
.00 .00 .00
TRAINING ASSESSMENT 115.90
ENDING BALANCE 115.90 .00 .00 1 115.90
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ENCLOSED ENVELOPE)
Frequently Asked Questions
What is the Worker Training Assessment?
In 2001, the Indiana General Assembly passed a law (HB1962) to provide a fund for incumbent worker
training and tasked the Indiana Department of Workforce Development with collecting this assessment.
"Incumbent" workers are those individuals who are currently employed.
How is it funded?
Employers are charged an assessment of .09% multiplied by their unemployment insurance(UI) taxable
wages for the previous calendar year.
Example: If an employer's previous calendar year taxable wage totals $7,000, the
assessment would be $6.30.
What impact did HB1962 have on employers' UI tax rates?
UI tax rate schedules A,B,C D were reduced by 0.1%.
Note: The Worker Training Assessment (HB1962) will not'affect an employer's fUl)
experience account.
How often will the assessment be mailed?
The law requires DWD to mail the assessment to employers on or before May 1 st of each year. Payment
of the assessment is due May 31 st of that same year. If a balance is due, a follow -up assessment notice
will be mailed to employers in November of that same year.
What will happen if the payment is postmarked after the due date?
A one -time penalty fee of $25.00 and an interest rate of 1 per month will be assessed.
Where should the payment and coupon for the assessment be mailed?
Please make payable and mail to:
Worker Training Fund
PO Box 6285
Indianapolis, IN 46206 -6285
What if I have additional questions or would like to apply for these funds?
Please call the Indiana Department of Workforce Development at (317) 232 -7436 or
(800) 891 -6499.
Note: Hours of Operation are 8:OOAM- 4:30PM, Monday- Friday
For more information, visit our website at:
www.in.gov /dwd /employers /employer_svcs.htmi
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
i (NO Z
t Purchase Order No.
4
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
70
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
Z-0&7-A IN SUM OF
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ON ACCOUNT OF APPROPRIATION FOR
13 G
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
g05 S� 70V1 Z7 /S, 90 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
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Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund