159708 05/21/2008 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
o t1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
CATY�MEL INDIANA 46032 DEVELOPMENT CHECK AMOUNT: $2,943.86
PO BOX 847
CHECK NUMBER: 159708
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 5/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4110000 2,943.86 FULL TIME REGULAR
i
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 IG 22- 4 -19 -6, IC 4 -1 -66
Page 1
CITY OF CARMEL ACCOUNT/
ATTN CLERK TREASURER ?35)does LOCATION NUMBER 133438 -000
ONE CIVIC SQ REPORTING MONTH APR, 2008
CARMEL IN 46032 -258
NETCHARGES $2,943.86
POSTING DATE MAY -04, 2008
The receipt of this statement (For notreopen the question of the claimant's eligibility for
un employment_ i since, before_an_y_payrnen#s_were_ made the emplcy_er had the opportunity
and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END I CLAIM WEEK AMOUNT
NUMBER EMPLOYEE'S NAME I DATE LEVEL DATE I 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 04/08
J E WALTON 10/25/08 REG 04/20/08 04/19/08 151.79
TOTAL NEW CHARGES FOR THE REPORTING MONTH 04/08 2,943.86
TOTAL AMOUNT OF NET CHARGES 2,943.86
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 Department of Workforce Development Terms
10 North Senate Ave.
Indianapolis, IN 46204 -2277
Description Amount
Number Invoice Invoice p
Date Num (or note attached invoice(s) or bill {s))
5/4108 133438 -000 April 08 Benefit Charges
2,943.86
Total 2,943.86
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.
t Indiana Department of Workforce Development Allowed 20
10 North Senate Ave.
Indianapolis, IN 46204 -2277
In Sum of
2,943.86
ON ACCOUNT OF APPROPRIATION FOR
101 General
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 133438 -000 4110000 2,943.86 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
nI received except
I I
I 15 Ma 2008
Si nat e
Q 36 Business Services Manager
Title