205703 01/30/2012 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $7,768.63
CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV
101 N SENATE AVE CHECK NUMBER: 205703
INDIANAPOLIS IN 46206 -0847
CHECK DATE: 1/30/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 R4350900 1,560.00 OTHER CONTRACTED SERV
1125 4111000 1,404.63 PART -TIME
1160 4110000 2,730.00 FULL TIME REGULAR
1207 4110000 1,972.00 FULL TIME REGULAR
601 5023990 102.00 OTHER EXPENSES
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 C I V I C S Q REPORTING MONTH DEC, 2011
CARMEL IN 46032 2584
NETCHARGES $7,768.63
POSTING DATE JAN -06, 2012
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
une1? lo i nsurance- si-ce� before any payments were made the employer had opportunit
and the responsibility to report any information which could disqualify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACC) 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 12/11
K PHILLIPS 06/02/12 REG 12/25/11 12/24/11 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/11 8,038.37
CONTINUE ON NEXT PAGE
An in the ACO column denotes a charge resulting from an acquisition of another business.
Account /Location Number: 133438 —000 Reporting Month: DECEMBER, 2011 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM TRANSACTIONI W EEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10 /11
M EDWARDS� 10/31/09 REG 12/28/11 12/20/08 16�44CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR
TOTAL AMOUNT OF NET CHARGES 7,768.63
END OF BENEFIT CHARGE STATEMENT
4
An in the AC column denotes a charge resulting from an acquisition of another business.
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.
In P ay
V` VU U Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
K1 r _1 7
Total g
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
l 1 lAJ ff Ifs lire
IN SUM OF
O (�J Se k kye
W 4�aq
77�9. b3
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
I e &C'0 bill(s) is (are) true and correct and that the
D 1 `K, p �73� materials or services itemized thereon for
((7rj 1 c which charge is made were ordered and
tJ 02 q I C17 received except
Id (nwo
s
S F 20'
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
O NE CIVIC S Q
C AftMEL IN 46032 258 i` �1 TR tr! x REPORTING MONTH DEC, 2011
JAN 17 2oi NETCHARGES $7,768.63
POSTING DATE JAN -0 6 2012
The receipt of this statement (Form 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 disqua!ify the claimant.
SOCIAL BENEFIT PAID FOR
SECURITY YEAREND CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING 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.
NEW CHARGES FOR THE REPORTING MONTH 12/11
K PHILLIPS 06/02/12 REG 12/25/11 12/24/11 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/11 8,038.37
CONTINUE ON NEXT PAGE
An in the ACQ column denotes a charge resulting from an acquisition of another business.
Account /Location Number: 133438 000 Reporting Month: DECEMBER, 2011 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL I T DATE ENDING ACO CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10 /11
M EDWARDS� 10/31/09 REG 12/28/11 12/20/08. 16.44CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR
TOTAL AMOUNT OF NET CHARGES 7,768.63
END OF BENEFIT CHARGE STATEMENT
o
An in the ACO 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 Amount
or note attached invoice(s) or bill(s)) PO
Date Number 1,404.63
1/6/12 133438 Unemployment char es Cit Acct/Parks Dept Dec'11
30305`
Total 1,404.63
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
1,404.63
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT AMOUNT Board Members
Dept TITLE
30305 133438 4110000 1,404.63 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
26 -Jan 2012
Signature
1,404.63 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277
Toll free 1- 800 891 -6499 Marron 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 DEC, 2011
CARMEL IN 46032 -2584
NETCHARGES $7,768.63
POSTING DATE JAN -06, 2012
The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for
unemployme it- insurance- since, before any payments were made the employer had -the- opportunity
and the responsibility to report any information which could disqualify the claimant.
S OCIAL BENEFIT P AID FOR I
SECURITY YEAR END CLAIM TRANISACTION WEEK AMOUNT
NUMBE EMPLOYEE'S NAME DATE LEVEL DATE ENDING 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.
NEW CHARGES FOR THE REPORTING MONTH 12/11
K PHILLIPS 06/02/12 REG 12/25/11 12/24/11 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/11 8,036.37
CONTINUE ON NEXT PAGE
An. in the ACQ column denotes a charge resulting from an acquisition of another business.
Account /Location Number: 133438 -000 Reporting Month: DECEMBER, 2011 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10 /11
M EDWARDS 10/31/09 REG 12/28/11 12/20/08. 16_44CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74CR
TOTAL AMOUNT OF NET CHARGES 7,768.63
END OF BENEFIT CHARGE STATEMENT
An in the ACO 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/31/11 Statement $2,730.00
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. WA N
ALLOWED 20
Indiana Department of Workforce Development
IN SUM OF
Benefit Administration, 10 N. Senate Ave
Indianapolis, IN 46204 -2277
$2,730.00
ON ACCOUNT OF APPROPRIATION FOR
Mayor's Office
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1160 Statement 41- 100.00 $2,730.00
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
Friday, January 27, 2012
Mayo
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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 -66
Page 1
CITY OF CARMEL ACCOUNT/
ATTN CLERK TREASURER LOCATION NUMBER 133438 —000
ONE C I V I C S Q REPORTING MONTH DEC, 2011
CARMEL IN 46032 -2584
NETCHARGES $7 ,768.63
POSTING DATE JAN -06 2012
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 disqualify the claimant.
S OCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NA DATE LEVEL DATE ENDING 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.
NEW CHARGES FOR THE REPORTING MONTH 12/11
K PHILLIPS 06/02/12 REG 12/25/11 12/24/11 390.00
TOTAL NEW CHARGES FOR THE REPORTING MONTH 12/11 6,038.37
CONTINUE ON NEXT PAGE
An. in the ACQ column denotes a charge resulting from an acquisition of another business.
Account/Location Number: 133438 —000 Reporting Month: DECEMBER, 2011 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 10 /11
M EDWARDS 10/31/09 REG 12/28/11 12/20/08. 16.44CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 12/08 74.74C
TOTAL AMOUNT OF NET CHARGES 7,768.63
END OF BENEFIT CHARGE STATEMENT
1 /f�
�o
1
�rt
SS'
aCau \S \Z \O'
achar9Q rQSV \��ng���r�
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
i performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
146500
IN DEPT OF WORKFORCE DEVEL. Purchase Order No.
10 N. Senate Avenue, Ste 106 Terms
Indianapolis, IN 46204 Due Date 12/30/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/30/201 1211 $102.00
t,
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
i
Date rbyl cer
VOUCHER 113590 WARRANT ALLOWED
146500
IN SUM OF
IN DEPT OF WORKFORCE DEVEL.�a:
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
1211 01- 4080 -12 $102.00
C..
Voucher Total $102.00
Cost distribution ledger classification if
claim paid under vehicle highway fund