HomeMy WebLinkAbout210610 07/10/2012 CITY OF CARMEL, INDIANA VENDOR: Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPARTMENT OF WORKFORC�p��E� pppM NNI
CARMEL, INDIANA 46032 ATTN: ACCTS RECEIVABLE CHEG�ECMD�N $3,000.00
10 N SENATE AVE CHECK NUMBER: 210610
INDIANAPOLIS, IN 46204 -2277
CHECK DATE: 7110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4110000 060112 3000.00 UNEMPLOYMENT
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 MAY, 2012
CARMEL IN 46032 2584
NET CHARGES $7,737.26
POSTING DATE JUN 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.
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING I ACO J 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,
CHARGES FOR THE REPORTING MONTH 05/12
N R GREEN 01/19/13 REG 05/21/12 05/19/12 163.98
TOTAL NEW CHARGES FOR THE REPORTING MONTH 05/12 7,871.67
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 02/11
307 -06 -3124 J N SPENCE 10/23/10 EB 05/31/12 02/05/11 �jGj� 115.21CR
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: MAY, 2012 Page 2
Employer Name: CITY OF CARMEL
SOCIAL BENEFIT PAID FOR
SECURITY YEAR END CLAIM WEEK AMOUNT
NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE ENDING I ACO CHARGED
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 02/11
J N SPENCE 10/23/10 EB 05/31/12 02/12/11 6.86CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 02/11 122.07CR
REVERSED CHARGES /CREDITS FOR THE PRIOR MONTH 01 /11
J N SPENCE 10/23/10 EB 05/31/12 01/29/11 12.34CR
TOTAL REVERSED CHARGES /CREDIT FOR THE PRIOR MONTH 01 /11 12.34CR
TOTAL AMOUNT OF NET CHARGES 7,737.26
END OF BENEFIT CHARGE STATEMENT
4
An in the ACQ 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.
f
Payee
l j LY Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1 ,7-1,
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.
�LOWED 20
w IN SUM OF
(b �j
�j �D
r
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
l bill(s) is (are) true and correct and that the
materials or services itemized thereon for
/6U 7 Lv which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
