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165623 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQ4JARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $4,700.19 a %+a' CARMEL, INDIANA 46032 DEVELOPMENT PO BOX 847 CHECK NUMBER: 165623 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 11/12/2008 DEPARTMENT ACCOUN T PO N INVOICE NUMBE AMOUNT DESCRIPTION 1125 4110000 i 2,360.19 FULL TIME REGULAR 1192 4110000 2,340.00 FULL TIME REGULAR i The following items apply to your benefit ACCOUNTNUMBER: 133438 charges posted in'AUGUST of 2008 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE 175.31 1.75 17.53 nr -PAYMENTS 175.31CR 00 00 ADJUSTMENT OF INTEREST/PENALTY 1.75CR 17 53CR n/r� p ENDING BALANCE .00 .00 .00 .00 The following items apply to your benefit ACCOUNT NUMBER: 133438 charges posted in SEPTEMBER of 2008 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE 1,890.00 -00 .DO'S' }ur: PAYMENTS 1,890.00CR .00 .00 i d�vo- 4 rte, ,'`p s r ENDING BALANCE .00 .00 .00 .00 THE TOTAL LIABILITY BALANCE IS LOCATED ON THE LAST PAGE OF THIS BILL. Additional interest will accrue at a rate of 1% per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If the liability is not paid in full, the Director may file with the clerk of the circuit court in your county, a warrant directing the sheriff to levy upon assets, in sufficient quantity to satisfy the amount of the warrant plus damages In the amount of 10 plus penalties and interest. 11 you have any questions, please call (800) 891 -6499 or (317) 232 -7395 and ask for Collections, REIMBURSABLE BILL ACCOUNT NUMBER: 133438 PAGE: 2 OF 2 DATE: NOVEMBER 01, 2008 The following items apply to your benefit charge posted i n OCTOBER of 2008 ACCOUNT NUMBER: 133438 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY i TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE .00 .00 00 z'aa `l F -ASSESSMENT OF BENEFIT CHARGES 5,132.12 r/ r A I: PAYMENTS 19.28CR .00 00 l� x ENDING BALANCE 5 .00 .00 5 THIS 1S YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $5,112.84 PAY THIS AMOUNT NO LATER THAN.......... NOVEMBER 30, 2008 Additional interest will accrue at a rate of 1% per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If the liability is not paid in full, the Director may file with the clerk of the circuit court in your county, a warrant directing the sheriff to levy upon assets, in sufficient quantity to satisfy the amount of the warrant plus damages in the amount of 10 plus penalties and 'interest. If you have any questions, please call (800) 891 -6499 or (3f 7) 232 -7395 and ask for Collections. ti 10 -16-08 All -4.5 IN 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toil 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 I CITY OF CARMEL ACCOUNT/ ATTN CLERK TREASURER LOCATION NUMBER 133438 -000 ONE CIVIC SQ REPORTING MONTH SEP, 2008 CARMEL IN 46032 2584 NETCHARGES $'5 132.12 POSTING DATE OCT -01, 2008 The receipt of this statement (Foram 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 PAID FOR SECURITY YEAR END CLAIM TRANSACTION I WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING I 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 09/08 V GRANT 07/04/09 REG 09/28/08 09/27/08 139.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 09/08 5,132.12 TOTAL, AMOUNT OF NET CHARGES 5,132.12 END OF BENEFIT CHARGE STATEMENT *x An in the AC© 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. n Payee Purchase Order No. l/yl��JCP Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 00 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 IN SUM OF A t /d (0 1 1v ON ACCOUNT OF APPROPRIATION FOR J-0c,5 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. II hereby certify that the attached invoice(s), or /00 -23gO.64ill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except ///0 20/(39 S a re��, Cost distribution ledger classification if Title claim paid motor vehicle highway fund The f cvll6.wing it.erms apply. to your b:enef;it ACCOUNT NUMBER: 133438 charges posted din YEUGUST of 2008. ACTIVITY SUMMARY BENEFIT'CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD I 4'j„ "4KS 2t .PREVIOUS BALANCE 17x3 1.75 17.53 NOV 0 5 2008 PAYMENTS 175_3.1CR 00 .00 -ADJUSTMENT OF INTEREST /PENALTY 1.75CR 17,.53CR i ff ENDING BALANCE 00 .00 .00 .00 The following items apply to your benefit ACCOUNT NUMBER: 133438 char es posted in SEPTEMBER 6f. 2008 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR :THE PERIOD_ PREVIOUS BALANCE 1,890.00 .00 .00 4 PAYMENTS 1,,69D.00 00 :00 ENDING BALANCE .00 .00 .00 00 THE TOTAL L BALANCE IS LOCATED ON THE LAST PAGE. O'FTHIS BILL. Additional interest will accrue at a rate of fro per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If the liability is not paid in full, the Director may file with the clerk of the circuit,court in, your county, a warrant directing the sheriff,to levy upon assets, In sufficient quantity to satisfy the amount of the warrant plus damages.in the amount of 10%, Plus pe nalties-0nd. irate re st. if °you, have any questions, please call(800) 891 =6499 or (317) 232 -7385 and ask for:Collections. REIMBURSABLE BILL ACCOUNT NUMBER: 133438' PAGE: 2 OF 2 DATE: NOVEMBER 01, 200.5 The following items .apply to your b.ene'f charges' posted: in OCTOBER of ,2008: AGCQU,NTNUMBER: 1334'38 ACTIVITY 5LlMIAARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD pREV1C1S BALANCE. 00 00 Oflr? C_R -ASSESSMENT BENEFIT CHARGES 5,,132;12 NOV 0 it 2008 -PAYMENTS 19.28CR .00 .00 �4 q) 1 a y ENDING BALANCE 5 112.84 QO fl0 5 THIS 1S YOUR TOTAL LIABILITY. PAYMENTS MAI LED-AFTER THE 20TH 'OF THE MONTH MAYNOT "BE REFLECTED °QN THIS. BILL. PLEASE, $5,112.84 PAY THIS AMOUNT NO LATER THAN NOVEMBER 30, 200.8 Additional 'inte[est will accrue at a rate of 1% per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the paymentdue'date. If the liability is not paid in full, the Director may file with the clerk of the circuit court in your county, a warrant directing the sheriff to levy upon assets, in sufficient quantity to satisfy the amount,of the warrant plus damages in the amount of 10°x, plus penalties and interest. It you have any questions, please _cali;(800) 891- 6489 (317) 232 -7395 and ask for Collections. f ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL I An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 11!1108 133438 Benefit charges Se '08 5,112.84 Total 5,112.84 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and 1 have audited same in accordance with IC 5- 11- 10-1.6 1 20 Clerk- Treasurer Voucher No. Warrant No. Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of$ $sue a ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 I hereby certify that the attached invoice(s), or a 0 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 7 -Nov 2008 Signature 5,112.84 Accounts Payable Coordinator Cost distribution ledger classification if Title ciairn paid motor vehicle highway fund