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Home My WebLink About168312 02/03/2009 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 f ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $6,763.49 CARMEL, INDIANA 46032 DEVELOPMENT •ti a� PO BOX 647 CHECK NUMBER: 168312 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 2/3/2009 DEPART ACCO PO NUMBER INV OICE NUMBER AMOUN DESCRIPTION 101 5023990 1,290.37 OTHER EXPENSES '1125 4110000 988.00 FULL TIME REGULAR 1192 4110000 3,900.00 FULL TIME REGULAR 4111000 585.12 PART -TIME 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 t 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 46032 -258 1 -22 -09 A09 :04 IN REPORTING MONTH DEC, 2008 NETCHARGES $6 ,763.49 POSTING DATE JAN 09, 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 employer had the opportunity and the responsibility to report any information which could disquality the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE I ENDING 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. ,7 NEW CHARGES FOR THE REPORTING MONTH 12/08 I E 0 EDEDUWA 07/25/09 REG 12/21/08 12/20/08 195.12 E O EDEDUWA 07/25/09 REG 12/29/08 12/27/08 390.00 V E HAAS 08/08/09 REG 12/02/08 11/29/08 182.00 5�5 E HAAS 08/08/09 REG 12/09/08 12/06/08 34.4 V A DOLAN 03/21/09 REG 12/03/08 11/15/08 390.00 V A DOLAN 03/21/09 REG 12/02/08 11/29/08 390.00 V A DOLAN 03/21/09 REG 12/09/08 12/06/08 390.00 LL V A DOLAN 03/21/09 REG 12/17/08 12/13/08 ALb,Q()390.00 V A DOLAN 03/21/09 REG 12/23/08 12/20/08 390.00 V A DOLAN 03/21/09 REG 12/30/08 12/27/08 390.00 R E BURY 08/01/09 REG 12/09/08 12/06/08 137.11 R E BURY 08/01/09 REG 12/16/08 12/13/08 C r,,� 168.00 I n R E BURY 08/01/09 REG .12/23/08 12/20/08 5 60 168.00 C1' R E BURY 08/01/09 REG 12/30/08 12/27/08 87.71 P K JACKSON 08/22/09 REG 12/01/08 11/29/08 197.00 Lj P K JACKSON 08/22/09 REG 12/07/08 12/06/08 5[99. \Z 197.00 C 1, 0 1 P P K JACKSON 08/22/09 REG 12/21/08 12/13/08 119.12 M R EDWARDS' 10/31/09 REG 12/03/08 11/15/08 217.40 M R EDWARDS- 10/31/09 REG 12/14/08 11/22/08 50.00 M R EDWARDS 10/31/09 REG 12/14/08 11/29/08 50..00 M R EDWARDS 10/31/09 REG 12/14/08 12/06/08 50.00 M R EDWARDS 10/31/09 REG 12/16/08 12/13/08 65.00 M R EDWARDS. 10/31/09 REG 12/22/08 12/20/08 85.00 K S BRENNAN 08/01/09 REG 12/05/08 11/29/08 390.00 I K S BRENNAN 08/01/09 REG 12/14/08 12/06/08 390.00 LI K S BRENNAN 08/01/09 REG 12/18/08 12/13/08 390. 00 K S BRENNAN 08/01/09 REG 12/28/08 12/20/08 390.00 L S BAILEY 04/04/09 REG 12/01/08 11/22/08 46.00 L S BAILEY 04/04/09 REG 12/11/08 11/29/08 84.00 CONTINUE ON NEXT PAGE Ar. he ACO column denotes a charge resulting from an acquisition of another business. Account /Location Number: 133438 —000 Reporting Month: DECEMBER, 2008 r Fage 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED NEW CHARGES FOR THE REPORTING MONTH 12/08 L S BAILEY 04/04/09 REG 12/15/08 12/06/08 67.00 L S BAILEY 04/04/09 REG 12/22/08 12/13/08 41( 137.00 L S BAILEY 04/04/09 REG 12/24/08 12/20/08 137.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/08 6,763.49 TOTAL AMOUNT OF NET CHARGES 6,763.49 END OF BENEFIT CHARGE STATEMENT &LM mar An in the ACQ column denotes a charge resulting from an acquisition of another business. 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 f Y (6L n/� Y 1 L J) J��r Y 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 v Board Members EP 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 20 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund 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 1 v Purchase Order No. /D /V �E$�'/�I� (fit; Terms r� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 3� sil Total S 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 PQCu -t ON ACCOUNT OF APPROPRIATION FOR Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Ja p7rD s; �i 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 Si nature 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. 166089 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 1/9/09 133438 Benefit charges Dec'08 988.00 PAY.ALL OUT OF 101; er Michael 1:1%20%08` f Total 988.00 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. 166089 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of of 988.00 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 1125 133438 4110000 988.00 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 2 -Feb 2009 Signature 988.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund