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Home My WebLink About204678 12/20/2011 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $4,996.78 CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV s "ti, px .�o 101 N SENATE AVE CHECK NUMBER: 204678 INDIANAPOLIS IN 46206 -0047 CHECK DATE: 1 212 012 01 1 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4110000 1,347.53 FULL TIME REGULAR 1125 4110000 1,465.25 FULL TIME REGULAR 1207 4111000 214.00 PART -TIME 601 5023990 1,950.00 OTHER EXPENSES 1 133438 -1� INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -22771 d li l f 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 NOV, 2011 CARMEL IN 46032 -2584 NETCHARGES $4,996,79 POSTING DATE DEC -02, 2011 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for `uiiempioym insu ran ce since, before' payments were made the employer -had the opportunity---- and the responsibility to report any information which could disqualify the claimant. SOCIA BENEFIT PA SECURITY YEAR END CLAIM R WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING 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 M EDWARDS 10/31/09 REG 11/22/11 12/13/08 6.70CR TOTAL REVERSED CHARGES /CREDIT�FOR THE PRIOR MONTH 12/08 74.74CR TOTAL AMOUNT OF NET CHARGES 4,996.79 7�7 CONTINUE ON NEXT PAGE 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. 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 12!6111 133438 Unemployment charges City Acct/Parks Dept Nov'11 1,485.25 Total 1,485.25 1 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 1 20 Clerk- Treasurer Voucher No. Warrant No. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE 106 Indianapolis, IN 46204 -2277 In Sum of 1,485.25 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT 1 AMOUNT Board Members Dept TITLE 1125 133438 4110000 1,485.25 1 hereby certify that the attached invoice(s), or bilf(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and recaived except 19 -Dec 2011 Signature 1,485.25 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund VOUCHER 113336 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 1111 01- 4080 -12 $1,950.00 I. I Voucher Total $1,950.00 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 DEVEI-. Purchase Order No. 10 N. Senate Avenue, Ste 106 Terms Indianapolis, IN 46204 Due Date 12/19/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12119/201' 1111 $1,950.00 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 Date Officer 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 R I A O Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) ,I 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 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 347. 3 materials or services itemized thereon for which charge is made were ordered and received except 1 .a p,,20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund