HomeMy WebLinkAbout204679 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $56.42
CARMEL, INDIANA 46032 DEVELOPMENT ATTN, ACCT RECV
t� 101 N SENATE AVE CHECK NUMBER: 204679
on
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 12/20/2011
DEPARTMENT ACCOUNT PO NUMBER IN VOIC E NUMBER AMOUNT DESCRIPTION
1125 4110000 676277 -000 56.42 FULL TIME REGULAR
676277 -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
CARMEL CLAY BOARD OF PARKS ACCOUNT/
AND RECREATION LOCATION NUMBER 676277 -000
1411 E 116TH ST REPORTING MONTH NOV, 2011
CARMEL IN 46032 3455
NETCHARGES $56.42
POSTING DATE DEC 02, 2011
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
�_a_ the' .J h n n few if�F_
unemployment insurance since bei'ore aii p ayrn ents w e r e mi a�. a
C he eimploye h the op7 irtun
and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE 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 11 /11
C ELLIS 08/25/12 REG 11/29/11 11/26/11 56.42
TOTAL NEW CHARGES FOR THE REPORTING MONTH 11 /11 56.42
TOTAL AMOUNT OF NET CHARGES 56.42
END OF BENEFIT CHARGE STATEMENT
c DEC 6 20
i1
�11
�L
An in the ACO 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.
146500 Indiana Dept. of Workforce Development
Terms
10 North Senate Ave., SE106 Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) PO
56.42
1216111 676277 Unemplo ment char es Parks Acct Nov'11
Total 56.42
1 hereby certify that the attached invoice(s), or bi11(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
56.42
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO #or INVOICE NO. ACCT 41 AMOUNT Board Members
Dept TITLE
1125 676277 4110000 56.42 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
15 -Dec 2011
Signature
56.42 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund