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Home My WebLink About211327 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1 ` ONE CIVIC SQUARE I N S C C U-ASFE ? CHECK AMOUNT: $330.00 CARMEL, INDIANA 46032 Po eox 6271 INDIANAPOLIS IN 46206-6271 CHECK NUMBER: 211327 CHECK DATE: 7/3112012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 330 . 00 OTHER EXPENSES THE EMPLOYEES LISTED BELOW OWE THE 2012 INDIANA ANNUAL SUPPORT FEE. • The remittance for the Annual Support Fee must be mailed separately to the special ASFE P O Box address listed below. • If one or more of the persons listed are no longer employed or have never been employed by your company,that information can be mailed with the payment or faxed to 317-234-4767. Retain a copy for your records and/or to send with additional payments in case multiple payments are necessary to pay the entire amount due. Employer Name: CITY OF CARMEL Make Check payable to: DBA: lNSCCU - ASFE FEIN: 356000972 P O Box 6271 Indianapolis IN 46206-6271 ''Employee's Name Employee's , Date of Last Day ISETS.Case#.- ,Amount ,Amount SSN W_orked or Due _ � Payfog . _ -. Never Em `loed , p y - per case . per=case CROMLICH, MARK A. $55.00 5: U� Order to Withhold Income , for the 2012 Indiana Annual Support Fee 1 Indiana Department of Child Services State Child Support Bureau Per Indiana Statutes IC-33-37-5-6 and IC-31-16-15 #BWNNXZL 07/14/2012 #9781 9996 43R# CITY OF CARMEL ONE CIVIC SQUARE ATTN KAREN HUFFMAN CARMEL IN 46032 04 This is an Order to W"_t!:ho!d;n conic for�hc 2�VIi 2 rinnuai Support Fee. This fee is 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 thereafter as practical. You may remit either in check form,which should be forwarded to the Indiana State Central Collection Unit(INSCCU),or electronically(please see instructions below). This deduction is in addition to any other child support or support-related payments you may be deducting. • General information: • This is a once a year fee deduction that should be made AFTER all other child support payments are deducted. If the child support obligation deducted each pay period always exceeds the CCPA limits,you cannot withhold the fee. The child support obligation,your fee,plus the ASFE combined,cannot exceed the CCPA limits. - • Even if you are not currently withholding child support for the employee(e.g.the non-custodial parent is paying directly), the ASFE fee still needs to be withheld. Employees with questions should contact the Kidsline at 317-233-5437 or 800- 840-8757. • A separate payment is required for this fee; do not combine the fee with regular child support payments. • You may retain a two dollar($2.00)fee from the employee's income for this withholding. • If you need the full SSN provided to you,please call 317-232-0327 or 1-800-292-0403 option 1. • Paving via Check: • Please complete the list on the reverse of this letter and send it with the payment to the address listed on the reverse. A copy of this list MUST accompany the payment,unless payments are sent electronically. • Please note that the P.O. Box for the fee payments is different than for regular child support payments. • If possible,please combine the Annual Support Fees withheld from all employees listed in a single check. • Paving Electronically: • The fee can be paid by using the Child Support Bureau's FREE Employer Online Payment System. If you're not currently using the site to process your regular child support payments,we can set you up to process the fees only.-Tor more --informati;n.c _r_c inb this proccss,-please call 3I7-232-6327 or 1-806-292-0463,option 1. • The fee CAN NOW also be sent electronically(ACH)but you must follow these instructions. Set up the fee as a separate child support deduction and add ASFE to the beginning of the ISETS case number as shown on the reverse of this document. ADP clients must use the P O Box 6219 as the payee address and add ASFE to the beginning of the ISETS case number,as only payments with this address will go electronically to Indiana. Ceridian clients must assign the garnishment INSDUI for the payments to go electronically. 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 EMUna DCS.IN.gov. SIGNATURE Cynthia Longest Deputy Director Department of Child Services Child Support Bureau 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 N S C C �/ gs Purchase Order No. 1 ,2 -71 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) ^ UD 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. z-2-3 ,,2o 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 materials or services itemized thereon for which charge is made were ordered and received except 7 d 7 20 1z .4�'-- 0M..X6w4& oe Signature /r Cost distribution ledger classification if Title claim paid motor vehicle highway fund