163112 09/02/2008 CITY OF CARMEL, INDIANA. VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
DEVELOPMENT CHECK AMOUNT: $4,615.17
CARMEL, INDIANA 46032
PO BOX 847 CHECK NUMBER: 163112
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 9/2/2008
DEPARTMEN A CCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESC
1125 4110000 4,615.17 UNEMPLOYMENT
C.
I
Pd A pr-
The following items apply to your benefit ACCOUNT NUMBER: 133438
charges posted t' JUNE of 2008 d -�c(h{ receive
ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY Ala y
FOR THE PERIOD
PREVIOUS BALANCE 1,.930.. -84'1 00 .00
c�
-P Jun Y J
-PAYMENTS 1 560.000R
.00 .00
-ASSESSMENT OF INTEREST PENALTY 3.71 37.08
i
l,r
ENDING BALANCE f 370.84 1 3.71 1 37.08 411.63
The following items apply to your benefit ACCOUNT NUMBER: 133438 F P --F CE1V E"
charges posted in JULY` of 2008 TOTAL LIABILI AUG 2 4 2008
ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY
FOR THE PERIO
PREVIOUS BALANCE 00- .00 .00 Y
-ASSESSMENT OF BENEFIT
CHARGES 1
0
J
ENDING BALANCE 1,560.00 .00 .00 1,560.00 �d
THIS IS YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH
OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $1,971.63
PAY THIS AMOUNT NO LATER THAN.......... AUGUST 31, 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 (317) 232 -7395 and ask for Collections.
133438 -1
INDIANA DEPARTMENT OF KFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1- 800 891 -6499 Marion County 232 -7436
l
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 CIVIC SQ REPORTING MONTH JUL, 2008
CARMEL IN 46032 -2584
NETCHARGES $2,643.54
POSTING DATE AUG-03, 2008
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 I PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL I T DATE ENDING A 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 07/08
C M BRODERICK 04/04/09 REG 07/30/08 07/26/08 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 07/08 2,643.54
TOTAL AMOUNT OF NET CHARGES 2,643.54
AUG 2 2008
END OF BENEFIT CHARGE STATEMENT
BY:
Ov -15 -0 P03 :41 IN
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.
Indiana Dept. of Workforce Development Terms
10 North Senate Ave., SE106 Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice i escription
Date Number
or note atted invoice(s) or bill(s)) Amount
1,971.63
8/1/08 133438 Benefit charges for '08 2,643.54
8/3/08 133438 Benefit charges for J8
W Total. 17
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.
Indiana Dept. of Workforce Development Allowed 20
10 North Senate Ave., SE106
Indianapolis, IN 46204 -2277
In Sum of
4,615.17
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT- Board Members
Dept TITLE
1125 133438 4110000 1,971.63 hereby certify that the attached invoice(s), or
1125 133438 4110000 2,643.54 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
25 -Aug 2008
Signature
4,615.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund