HomeMy WebLinkAbout172692 05/26/2009 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $1;885.18
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
101 N SENATE AVE CHECK NUMBER: 172692
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 5/26/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTIO
101 5023990 272.53 OTHER EXPENSES
1125 4110000 1,612.65 FULL TIME REGULAR
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 APR, 2009
CARMEL IN 46032 2584
NET CHARGES $1 ,885.18
POSTING DATE 14AY -03, 2009
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_.emplover_ had the opportunity-
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 I 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 04/09
i S L MINNICK 12/26/09 REG 04/05/09 04/04/09 244.00
S L MINNICK \A1 12/26/09 REG 04/12/09 04/11/09 0 0244.00
_S L MINNICK 12/26/09 REG 04/19/09 04/18/09 ��(p' 244.00
L MINNICK 12/26/09 REG 04/26/09 04/25/09 244.00
R KLEMEN OL1� 01/09/10 REG 04/12/09 04/11/09 330.31
R KLEMEN l 01/09/10 REG 04/20/09 04/18/09 2j 5.67
S S TROSPER 10/10/09 REG 04/08/09 04/04/09 .79
S S TROSPER 0 /z� 10/10/09 REG 04/14/09 04/11/09 77.00
S S TROSPER 10/10/09 REG 04/21/09 04/18/09 v7i 53.00
i __S_ S_TR OSPE R-- 10/10/09 REG 04/27/09 04/25/09 53.00
M R EDWARDS 10/31/09 REG 04/17/09 04/04/09 17.5
M R EDWARDS 10/31/09 REG 04/17/09 04/11/09 j 00 125.67
L M BREWER_ _12/12/09 _REG 04 /12/09 04/11/09 r. 1. __48.98
L M BREWER 12/12/09 REG 04/19/09 04/18/09 �Q.� 1.76
TOTAL NEW CHARGES FOR THE REPORTING MONTH 04/09 1,885.18
TOTAL AMOUNT OF NET CHARGES 1,885.18
The following charge(s) are POTENTIAL credits to your account. A determination was made and you were found not
liable for these charges. But because you have chosen to make payment in lieu of contributions for Unemployment
Insurance, your account cannot be credited for these charges unless or until the claimant(s) refund the overpayment.
Your account will be credited as the claimant refunds the overpayment in full or in monthly installments.
R EDWARDS 10/31/09 REG 11/15/08 217.00
R EDWARDS 10/31/09 REG 11/22/08 50.00
R EDWARDS 10/31/09 REG 11/29/08 50.00
M R EDWARDS 10/31/09 REG 12/06/08 50.00
M R EDWARDS 10/31/09 REG 12/13/08 65.00
An in the ACO column denotes a charge resulting from an acquisition of another business.
Account /Location Number: 133438 000 Reporting Month: APRIL, 2009 Page
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
The following charge(s) are POTENTIAL credits to your account. A determination was made and you were found not
liable for these charges. But because you have chosen to make payment in lieu of contributions for Unemployment
Insurance, your account cannot be credited for these charges unless or until the claimant(s) refund the overpayment.
Your account will be credited as the claimant refunds the overpayment in full or in monthly installments.
M R EDWARDS 10/31/09 REG 12/20/08 85.00
M R EDWARDS 10/31/09 REG 12/27/08 160.00
M R EDWARDS 10/31/09 REG 01/03/09 135.00
M R EDWARDS 10/31/09 REG 01/10/09 160.00
M R EDWARDS 10/31/09 REG 01/17/09 160.00
M.R EDWARDS 10/31/09 REG 01/24/09 175.00
M R EDWARDS 10/31/09 REG 01/31/09 175.00
M R EDWARDS 11 10/31/09 REG 02/07/09 175.00
M R EDWARDS �`W 10/31/09 REG 02/14/09 175.00
M R EDWARDS 10/31/09 REG 02/21/09 175.00
M R EDWARDS 10/31/09 REG 02/28/09 175.00
..M R EDWARDS 10/31/09 REG 03/07/09 175.00
M R EDWARDS 10/31/09 REG 03/14/09 175.00
M R EDWARDS 10/3.1/09- REG 03/21/09 175.00
M R EDWARDS 10/31/09.: REG 03/28/09 175.00
M R EDWARDS 10/31/09 REG 04/04/09 175.00
M R EDWARDS 10/31/09 REG 04/11/09 125.67
�l
END OF BENEFIT CHARGE STATEMENT
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An in the ACQ column denotes a charge resulting from an acquisition of another business.
:riled by State Board of Accounts City Form No. 201 (Rev. 1995)
Y 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
l' Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
materials or services itemized thereon for
which charge is made were ordered and
received except
A 20
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
r Purchase Order No.
146500 Indiana Dept. of Workforce Development Terms
10 North Senate Ave., SE 106 Date Due
Indianapolis, IN 46204 -2277
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
513109 133438 Benefit charge A r'09 1,612.65
PAY ALL OUT, Q,F j t' r ervMichael 1'1720/08 E
Total 1,612.65
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
,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
1,612.65
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
1125 133438 4110000 1,612.65 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
21 -May 2009
Signature
1,612.65 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund