172120 04/30/2009 f CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
CHECK AMOUNT: $3,513.45
s?,z CARMEL, INDIANA 46032 DEVELOPMENT
PO BOx 847 CHECK NUMBER: 172120
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 4130/2009
DEPARTME AC COUNT y PO NUMBER INVOICE NUMBER AMOU DESC
101 y_ 5023990 1,297.74 UNEMPLOYMENT
1125 4110000 107.22 UNEMPLOYMENT
1125 R4110000.19678 2,108.49 UNEMPLOYMENT CLAIMS
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
CARMEL IN 46D32 -2584 REPORTING MONTH MAR, 2009
NETCHARGES $3 ,513.45
POSTING DATE APR 2 0 0 9
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 m ade. the employ had the opportunity.
and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END I CLAIM I WEEK AMOUNT
NUMBER EMPLOYEE'S NAME I 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 03/09
S L MINNICK 12/26/09 REG 03/01/09 02/28/09 244.00
S L MINNICK 12/26/09 REG 03/08/09 03/07/09 �,j 244.00
S L MINNICK 12/26/09 REG 03/15/09 03/14/09 L 244.00
3 L MINNICK 12/26/09 REG 03/22/09 03/21/09 244.00
S L MINNICK 26 EG 03/29/09 03/28/09 244.00
R KLEMEN 01/09/10 REG 03/08/09 03/07/09 (OV 116.84
J M MURPHY 10/24/09 REG 03/09/09 03/07/09 2
V A DOLAN 03/21/09 REG 03/03/09 02/28/09 390.00
V A DOLAN 03/21/09 REG 03/11/09 03/07/09 !T 390.00
V A DOLAN 03/21/09 REG 03/25/09 03/21/09
R S BLAIR 09/19/09 REG 03/08/09 03/07/09 120 1
M R EDWARDS 10/31/09 REG 03/02/09 02/26/09 17
M_ R EDWARDS 3:0/31/09 REG. 03 /Oo /no 0' /n r
R EDWARDS 10/31/09 REG 03/17/09 03/14/09 175.00
R EDWARDS 10/31/09 REG 03/23/09 03/2.1/09 v 175.00
M R EDWARDS 10/31/09 REG 03/30/09 03/28/09 175.00
M L DEAN 02/06/10 REG 03/22/09 03/21/09 2.60
TOTAL NEW CHARGES FOR THE REPORTING MONTH 03/09 3,513.45
TOTAL AMOUNT OF NET CHARGES 3,513.45
END OF BENEFIT CHARGE STATEMENT
An in the ACO column denotes a charge resulting from an acquisition of another business.
Prescrib )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
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
[�1 swim T
L� b A #rf Board Members
Pp# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
cj ].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
Signature
Cost distribution ledger classification it Title
claim paid motor vehicle highway fund
ACCOUNTS PAYABLE VOUCHER
w 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)) Amount
413/09 133438 Benefit charges Mar'09 2,215.71
P 4Y ALL; OUT, OF 1K01,; er,Michael `11 /20108
Total 2,215.71
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
2,215.71
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT f AMOUNT Board Members
Dept TITLE
19678 F 133438 4110000 2,215.71 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
30 -Apr 2009
Signature
2,215.71 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund