HomeMy WebLinkAbout200316 08/17/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $9,323.85
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
101 N SENATE AVE CHECK NUMBER: 200316
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 8/17/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4110000 073011 1,560.00 FULL TIME REGULAR
1115 4110000 073011 780.00 FULL TIME REGULAR
1120 4110000 073011 1,560.00 FULL TIME REGULAR
1125 4110000 073011 3,473.85 FULL TIME REGULAR
601 5023990 073011 1,950.00 OTHER EXPENSES
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 (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 C I V I C S Q REPORTING MONTH JUL, 2011
CARMEL IN 46032 -2584
NETCHARGES $9,323.85
POSTING DATE AUG 05, 2011
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
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and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END I CLAIM RANSACTION WEEK I l AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE I 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 (Form 1067) for these charges and any previous liability still outstanding.
NEW CHARGES FOR THE REPORTING MONTH 07/11
J L HOPE 08/14/10 EB 07/26/11 07/23/11 390.00
CONTINUE ON NEXT PAGE
An in the ACO column denotes a charge resulting from an acquisition of another business.
Account/Location Number: 133438 000 Reporting Month: JULY, 2011 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 ACQ CHARGED
NEW CHARGES FOR THE REPORTING MONTH 07/11 6 L 7
K PHILLIPS 06/02/12 REG 07/25/11 07/23/11 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 07/11 9
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 12/08
312 -98 -2537 M EDWARDS 10/31/09 REG 07/25/11 11/15/08 74.74CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR
TOTAL AMOUNT OF NET CHARGES 9,323.85
END OF BENEFIT CHARGE STATEMENT
,i
An in the ACQ column denotes a charge resulting from an acquisition of another business.
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 JJ
v Nff 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
(nd Val
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT# /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
25 qj 16D D 73 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
f ,0 which charge is made were ordered and
received except
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eAMAV
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund