174939 07/22/2009 "yf CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1
ONE CIVIC SQUARE INDIANA STATE CENTRAL COLLECTIO
CARMEL, INDIANA 46032 UNITASFE C, HECKAMOUNT: $220.00
PO Box 6271 CHECK NUMBER: 174939
INDIANAPOLIS IN 46206 -6271
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBE AMO DESCRIPTION
101 5023990 220.00 OTHER EXPENSES
r
117U1AnA a l A 1 C l.Cn 11{AL 6ULLC6 11Vn Vr111 Aar C l lna"U Aar C J
P.O. SOX 6271
INDIANAPOLIS, IN 46206 -6271 Date:06 /13/2009
Order to Withhold Income for Indiana Annual Support Fee
CITY OF CARMEL
This is an Order to Withhold Income for the annual fee charged to non custodial parents pursuant
to Indiana statute. You are required by law, IC 33- 37 -5 -6 and IC 31 -16 -15 to deduct these amounts
from the employee's income. The deduction should be made from the next payroll, or as soon there-
after as practical, and forwarded to the Indiana State Central Collection Unit. This deduction is
in addition to any other child support or support- related payments you are deducting.
Special payment instructions:
This is a once yearly deduction that should be made AFTER all other child support payments are
deducted.
Complete and enclose the list provided below; this list MUST accompany the payment.
G A separate check is required for this fee; do not combine the withheld amounts with other
child support payments.
The Annual Support Fees withheld from all employees listed below should be combined in a
single fee payment check, if possible.
The remittance for the Annual Support Fee must be mailed separately to the address referenced
below on the coupon.
This special remittance cannot be made by Electronic Funds Transfer (EFT)or by Electronic Data
Interchange (EDI).
You may retain a two dollar ($2.00) fee from the non custodial parent's income for this
income withholding.
For your convenience, you may pay the Annual Support fee online at the Indiana Child Support Payment
website: www.empehildsupport.in.gov
I
Consumer Credit Protection Act (CCPA): Federal law requires states to limit the amount which can be
collected by income withholding to 60% of disposable earnings per pay period, or 50 of disposable
earnings if your employee is supporting another spouse or dependent child (current family). If
earnings are not sufficient to make the full payment (which may include the $2.00 fee), partial
deductions should be made up to the CCPA limit. If you have any questions, please contact the Child Support
Bureau EMPLOYER MAINTENANCE UNIT (EMU) at 317- 232 -0327 OR 1- 800 292 -0403 or EMUaDCS.IN.GOV
CYNTHIA LONNGMT�
DEPUTY DIRECTOR
DEPARTMENT OF CHILD SERVICES
CHILD SUPPORT BUREAU
ASFE Income Withh Order, State Form 53260 (R/11 -07) /CAS 00046 Approved by State Board of Accounts, 2007
PRESORTED
FIRST CLASS MAIL
US POSTAGE PAID
CAS 00046 PERMIT 4583
INDIANA STATE CENTRAL COLLECTION UNIT ASFE INDIANAPOLIS, IN
P.O. BOX 6271
INDIANAPOLIS, IN 46206 -6271
Address Service Requested
#BWNNXZL
#9781 9996 43R#
CITY OF CARMEL
ONE CIVIC SQUARE
ATTN KAREN HUFFMAN
CARMEL, IN 46032
E ?RPI 46030 141t[III1„III„IJ111,1f [It 11111111111 IfdilIll """I III flid
INDIANA STATE CENTRAL COLLECTION UNIT ASFE (INSCCU ASFE)
P.O. BOX 6271
INDIANAPOLIS, IN 46206 -6271 Date:06 /13/2009
Order to Withhold Income for Indiana Annual Support Fee
CITY OF CARMEL
This is an Order to Withhold Income for the annual fee charged to non custodial parents pursuant
to Indiana statute. You are required by law, IC 33- 37 -5 -6 and IC 31 -16 -15 to deduct these amounts
from the employee's income. The deduction should be made from the next payroll, or as soon there
after as practical, and forwarded to the Indiana State Central Collection Unit. This deduction is
in addition to any other child support or support related payments you are deducting.
Special payment instructions:
o This is a once- yearly deduction that should be made AFTER all other child support payments are
deducted.
o Complete and enclose the list provided below; this list MUST accompany the payment.
o A separate check is required for this fee; do not combine the withheld amounts with other
child support payments.
o The Annual Support Fees withheld from all employees listed below should be combined in a
single fee payment check, if possible.
o The remittance for the Annual Support Fee must be mailed separately to the address referenced
below on the coupon.
O This special remittance cannot be made by Electronic Funds Transfer (EFT)or by Electronic Data
Interchange (EDI).
o You may retain a two dollar ($2.00) fee from the non custodial parent's income for this
income withholding.
For your convenience, you may pay the Annual Support fee online at the Indiana Child Support Payment
website: www.empchildsupport.in.gov
Consumer Credit Protection Act (CCPA): Federal law requires states to limit the amount which can be
collected by income withholding to 60% of disposable earnings per pay period, or 50% of disposable
earnings if your employee is supporting another spouse or dependent child (current family). If
earnings are not sufficient to make the full payment (which may include the $2.00 fee), partial
deductions should be made up to the CCPA limit. If you have any questions, please contact the Child Support
Bureau EMPLOYER MAINTENANCE UNIT (EMU) at 317 232-0327 OR 1- 800 292 -0403 or EMUaDCS.IN.GOV
CYNTHIA LONGEtT
DEPUTY DIRECTOR
DEPARTMENT OF CHILD SERVICES
CHILD SUPPORT BUREAU
ASFE Income Withholding Order, State Form 53260 00046 Approved by State Board of Accounts, 2007
DETACH COUPON AND RETURN WITH FEE PAYMENT
Date of Withholding: Make check payable to:
Employer Nama:CITY OF CARMEL INDIANA STATE CENTRAL COLLECTION UNIT ASFE (INSCCU ASFE)
Employer FEIN:356000972 P.O. BOX 6271
INDIANAPOLIS, IN 46206 -6271
Employee's Name Employee's Employee's Employee Amount Amount Paid on
SSN ISETS Case No Longer Due on Case
Number Employed Case
if a
applicable
N
f CARTER, MARCUS L. 312 -74 -3975 0003671874 $55.00
COLLINS, WILLIE H. 304 -84 -7381 0005291191 $55.00
J COLLINS, WILLIE H. 304 -84 -7381 0002837838 $55.00
COLLINS, WILLIE H. 304 -84 -7381 0004324952 $55.00
i
E
M
D
ASFE Income Withholding Order, State Farm 53260 (R /11-07) /CAS 00046 Approved by State Board of Accounts, 2007
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
z Gyz I u chase Order No.
r
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
C9 00 3 �r 7 Iry
vas'
6 /3 -0" 007 Zg2 wS 5 v;
Total ap
hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in acco dance
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
J O0o3 &7IS 7V S�Z .5 5 &-o bill(s) is (are) true and correct and that the
aoo.sa 9 0 23 ?,F-1 SS tAD materials or services itemized thereon for
000a83�83d vv which charge is made were ordered and
U o v 5�3a 9sz Sa�3 ppa 5 5 crO received except
1 2,
4o ature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund