HomeMy WebLinkAbout211113 07/18/2012 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE
CARMEL,INDIANA 46032 DEVELOPMENT ATTN ACCT RECV CHECK AMOUNT: $5,112.07
10 N SENATE AVE
CHECK NUMBER: 211113
INDIANAPOLIS IN 46204-2277
CHECK DATE: 7/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4110000 133438 1, 392 . 00 FULL TIME REGULAR
1203 4110000 133438 1, 316 . 60 FULL TIME REGULAR
1301 4110000 133438 -20 . 14 FULL TIME REGULAR
2201 4110000 133438 1, 560 . 00 FULL TIME REGULAR
1125 R4110000 30305 133438 863 . 61 UNEMPLOYMENT
133438 -1
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS,IN 46204-2277
Toll frees-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 JUN, 2012
CARMEL IN 46032-2584
NET CHARGES $5, 112 .07
POSTING DATE JUL-08, 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 RANSACTION WEEK AMOUNT
NUMBER EMPLOYEE'S NAME DATE I LEVEL DATE I 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 06/12 ***
M CALLAHAN 01/19/13 REG ' 06/03/12 06/02/12 390.00
D B JACKSON Jt 12/15/12 REG 06/10/12 06/09/12 p 125.00 9
---------------
TOTAL NEW CHARGES FOR THE REPORTING MONTH 06/12 5,132.21
*** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 09/10 ***
D A HUGHES 08/20/11 REG 06/04/12 09/18/10 14CR
---------------20
TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 : 20.14CR
---------------
---------------
TOTAL AMOUNT OF NET CHARGES : 5,112.07
An (*) in the ACID column denbt4sF&2hWg sWirq §R1hWMtibV6f another business.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm 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.
1 Pay e
VAa ,, a 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
Board Members
PO#or
D PT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
3( (off materials or services itemized thereon for
l U (b which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund