155159 01/08/2008 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
CARMEL, INDIANA 46032 DEVELOPMENT CHECK AMOUNT: $929.64
10 N SENATE AVE, SE106 CHECK NUMBER: 155159
INDIANAPOLIS IN 46204 -2277
CHECK DATE: 1/812008
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1301 4111000 133438 336.32 PART -TIME
1125 R4110000 17989 133438 593.32 UNEMPLOYMENT FEES
The following items apply to your benefit ACCOUNT NU MBER: 133438
charges posted in NOVEMBER of 2007 1.
ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY
FOR THE PERIOD
PREVIOUS BALANCE 1 .00 .00
PAYMENTS 1 506.32CR .00 .00
ENDING BALANCE .00 .00 .00 .00
The following items apply to your benefit ACCOUNT NUMBER: 133438
charges posted in DECEMBER of 2007
ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY
FOR THE PERIOD
PREVIOUS BALANCE .00 .00 .00
ASSESSMENT OF BENEFIT CHARGES 983.32
-PAYMENTS 53.68CR .00 .00
ENDING BALANCE 929.64 .00 .00 929.64
THIS IS YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH
OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $929.64
PAY THIS AMOUNT NO LATER THAN.......... JANUARY 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 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 1C 22- 4 -19 -6, IC 4 -1 -66
Page 1
CITY OF CARMEL ACCOUNT/
ATTN CLERK TREASURER LOCATION NUMBER 133438 —000
ON'E CIVIC SQ REPORTING MONTH NOV, 2007
CARMEL IN 46032 DEC rt ZQa7
1 NETCHARGES $983.32
POSTING.DATE DEC 04, 2007
The receipt of this statement,(Forrr. 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 TRANSACTON WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DAT I ENDING AGO 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 11/07
im REG 11/01/07 10/27/07 390.00
dMAIM REG .11/07/07 11/03/07 203.32
TOTAL NEW CHARGES FOR THE REPORTING MONTH 11/07 983.5-2—
TOTAL AMOUNT OF NET CHARGES
S9 3 3 a
END -OF- BENEFIT- CHARGE. STATEMENT
f1
An in the ACO' column denotes a charge resulting from an acquisition of another business.
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
r
`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 N. Senate Ave.
Indianapolis, IN 46204 -2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1214107 133438 Unemployment benefit charges 553.32
Total 593.32
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.
Indiana Dept. of Workforce Development Allowed 20
10 N. Senate Ave.
Indianapolis, IN 462042277
In Sum of
593.32
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
17989F 133438 4110000 593.32 1 hereby certify that the attached invoice(s), or
1 C (ZzGU J4� 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
4 -Jan 2008
S t t (icManager
e
593.32 Businese
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund