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Home My WebLink About213814 10/22/2012 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: $6,183.88 10 N SENATE AVE CHECK NUMBER: 213814 INDIANAPOLIS IN 46204-2277 CHECK DATE: 10/22/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 133438 -704 . 00 FULL TIME REGULAR 1115 4110000 133438 3, 080 . 55 FULL TIME REGULAR 1120 4110000 133438 1, 560 . 00 FULL TIME REGULAR 1125 4110000 133438 246 . 05 133438 1180 4110000 133438 1, 593 .47 FULL TIME REGULAR 1301 4110000 133438 -20 . 14 FULL TIME REGULAR 1125 R4110000 30305 133438 427 . 95 UNEMPLOYMENT 1 133438 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 1.0 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 SEP, 2012 CARMEL IN 46032-2584 NETCHARGES $6,18.3.88 POSTING DATE OCT-05, 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 �TRANSACTION 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 09/12 *** G A PARK Q U� 02/18/12 REG 09/24/12 04/30/11 62.00CR I --------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 05/11 704.00CR *** 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: SEPTEMBER, 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 ACO CHARGED *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 09/10 *** D A HUGHES / 08/20/11 REG 09/12/12 09/18/10 --------20�14CR TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 20.14CR --------------- --------------- TOTAL AMOUNT OF NET CHARGES 6,183.88 *** END OF BENEFIT CHARGE STATEMENT **** � P 1� 0'G�l� An in the ACQ column denotes a charge resulting from an acquisition of another business. VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204 $1,560.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members 1120 I I 41-100.00 I $1,560.00 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 OCT 2 2 2012 1- Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) $1,560.00 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. ALLOWED 20 Indiana Department of Workforce Development Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 ($704.00) ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 41-100.00 ($704.00) I hereby certify that the attached invoice(s), or I I 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 Thursday, October 18, 2012 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 10/22/12 credit/Park ($704.00) 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 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 Date Number (or note attached invoice(s) or bill(s)) PO# Amount 10/5/12 133438 Unemployment charges City Acct/Parks Dept Sep'12 $ 427.95 10/5/12 133438 Unemployment charges City Acct/Parks Dept Sep'12 $ 246.05 Total $ 674.00 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 5-11-10-1.6 120 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$ $ 674.00 ON ACCOUNT OF APPROPRIATION FOR 101-General Fund PO#or INVOICE NO. ACCT#/ AMOUNT Board Members Dept# TITLE 30305 F 133438 4110000 $ 427.95 1 hereby certify that the attached invoice(s), or 1125 133438 4110000 $ 246.05 bill(!)is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 18-Oct 2012 Signature $ 674.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund