161677 07/22/2008 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
I CARMEL, INDIANA 46032 DEVELOPMENT CHECK AMOUNT: $1,560.00
PO BOX 847 CHECK NUMBER: 161677
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 7/22/2008
DEPA RTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1125 4110000 1,560.00 FULL TIME REGULAR
133438 -1
4 INDIANA DEPARTMENT OF .WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE INDIANAPOLIS, IN 46204 -2277
T611 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 CIVIC SQ REPORTING MONTH JUN, 2008
CAR'MEL IN 46032 -2584
NETCHARGES $1,560.00
POSTING DATE JUL 01, 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 responsibilityto report:any information which could disqualify the.claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE, I 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 06/08
C M BRODERICK 04/04/09 REG 06/25/08 06/21/08 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 06/08 1,560.00
TOTAL AMOUNT OF`NET CHARGES 1,560.00
END OF BENEFIT CHARGE STATEMENT
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 Avenue Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/1/08 133438- Jun'08 June 2008 Benefit charges 1,560.00
Total 1,560.00
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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Indiana Dept. of Workforce Development Allowed 20
10 North Senate Avenue
Indianapolis, IN 46204 -2277
In Sum of
1,560.00
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
1125 133438- Jun'08 4110000 1,560.00 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
16 -Jul 2008
'P' bjvumj
Signature
1,560.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund