HomeMy WebLinkAbout158258 04/15/2008 e, �q1r CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
y e yp8�� CARMEL, INDIANA 46032 DEVELOPMENT CHECK AMOUNT: $1,163.28
PO BOX 847 CHECK NUMBER: 158258
°k INDIANAPOLIS IN 46206 -0647
CHECK DATE: 411 5120 0 8
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 1,163.28 UNEMPLOYMENT
I
The following items apply to your benefit
charges p9sted t BRUARY of 2008 ACCOUNT NUMBER: 133438
ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY
FOR THE PERIOD
PREVIOUS BALANCE 1 .00 .00
ASSESSMENT OF INTEREST /PENALTY
10.48 104.80
ENDING BALANCE 1,048.00 10.48 104.80 1,163.28
THIS IS YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH
OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $1,163.28
PAY THIS AMOUNT NO LATER THAN.......... APRIL 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 (317) 232 -7395 and ask for Collections.
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 CIVIC SQ REPORTING MONTH JAN, 2008
CARMEL IN 46032
NET CHARGES $1,048.00
POSTING DATE FEB 06, 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 PAID FOR
SECURITY YEAR END I CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME 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 01/08
I MOGLIA— HAWKINS 09/27/08 REG 01/18/08 01/12/08 268.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 01/08 1,048.00
TOTAL AMOUNT OF NET CHARGES 1,048.00
GE S EMENT
An in the ACO column denotes a charge resulting from an acquisition of another business.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
luW44
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.
W o ALLOWED 20
-(C- M V 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
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
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund