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Home My WebLink About202881 10/24/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $6,225.05 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV 101 N SENATE AVE CHECK NUMBER: 202881 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 10/24/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 1,508.00 FULL TIME REGULAR 1115 4110000 1,560.00 FULL TIME REGULAR 1125 4110000 1,597.05 FULL TIME REGULAR 601 5023990 1,560.00 OTHER EXPENSES 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 SEP, 2011 CARMEL IN 46032 -2584 NET CHARGES $6 POSTING DATE j OCT -07, 2011 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for _unemployment insuranc 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 I WEEK AMOUNT NUMBER EMPLOYEE'S NAME I DATE LE DATE ENDI I ACO 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 09/11 K PHILLIPS 06/02/12 REG 09/26/11 09/24/11 390.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 09/11 6,367.00 REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 01 /11 307 -06 -3124 J N SPENCE 10/23/10 EB 09/28/11 01/29/11 67.21CR /LCJ TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 01 /11 67.21CR �1J CONTINUE ON NEXT PAGE An in the ACQ column denotes a charge resulting from an acquisition of another business. Account/Location Number: 133438 —000 Reporting Month: SEPTEMBER, 2011 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL I T DATE ENDING ACO CHARGED REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 12/08 M EDWARDS 10/31/09 REG 09/20/11 11/22/08 7.22CR TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR TOTAL AMOUNT OF NET CHARGES 6,225.05 END OF BENEFIT CHARGE STATEMENT 1�v An in the ACO column denotes a charge resulting from an acquisition of another business. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 f 1 l��l� r Q�)� Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) VS 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. ALLOWED 20 r 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 1 bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 0d0 lS M L Il00 0b `zr 20 c� Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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. 146500 Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 1017!11 133438 Unemployment charges City Acct/Parks Dept Sep'11 1,597.05 Total 1,597.05 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. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of 1,597.05 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 1,597.05 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 20 -Oct 2011 Signature 1,597.05 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund VOUCHER 112729 WARRANT ALLOWED 146500 IN SUM OF IN DEPT OF WORKFORCE DEVEL. 10 N. Senate Avenue, Ste 106 Indianapolis, IN 46204 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 133438 01- 4080 -12 $1,560.00 I Voucher Total $1,560.00 Cost distribution ledger classification if claim paid under vehicle highway fund 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 146500 IN DEPT OF WORKFORCE DEVEL. Purchase Order No. 10 N. Senate Avenue, Ste 106 Terms Indianapolis, IN 46204 Due Date 10/20/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/20/201' 133438 $1,560.00 hereby certify that the attached invoice(s), or bill(s) is (are) true and orrect and I have audited same in accordance with IC 5-11-10-1.6 I Date Officer