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Home My WebLink About214527 11/19/2012 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 } ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE € CHECK AMOUNT: $15,954.43 s; = CARMEL, INDIANA 46032 DEVELOPMENT ATTN.ACCT RECV 10 N SENATE AVE CHECK NUMBER: 214527 INDIANAPOLIS IN 46204-2277 CHECK DATE: 11119/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 1, 988 . 00 FULL TIME REGULAR 1115 4110000 12, 036 . 57 FULL TIME REGULAR 1120 4110000 1, 950 . 00 FULL TIME REGULAR 1301 4110000 -20 . 14 FULL TIME REGULAR 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 SO CARMEL IN 46032-2584 REPORTING MONTH OCT, 2012 NET CHARGES $15,954.43 4 POSTING DATE NOV-02, -,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 cppertUnity 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 ACQ .- CHARGED , [. THIS AS 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 10/12 *** P D GORDON 08/31/13 REG 10/18/12 10/13/12 390.00 *** 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: OCTOBER, 2012 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM R WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED *** NEW CHARGES FOR THE REPORTING MONTH 10/12 *** L H MOORE _ 07/06/13 REG 10/28/12 10/27/12 `� . 304.11_ TOTAL NEW CHARGES FOR THE REPORTING MONTH 10/12 : 16,326.57 *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 05/11 *** G A PARK 02/18/12 REG 10/07/12 05/07/11 24.000R TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 05/11 352.00CR *** REVERSED HARGES/CREDITS FOR THE PRIOR MONTH 09/10 A HUGHES 08/20/11 REG 10/10/12 09/18/10 20.14CR --------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 : 20.14CR TOTAL AMOUNT OF NET CHARGES : 15,954.43 *** END OF BENEFIT CHARGE STATEMENT **** An {*) in the AC® column denotes a charge resulting from an acquisition of another business. VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 $1,988.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 41-100.00 $1,988.00 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 Friday, November 16, 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)) 11/02/12 unemployment charges- Herron $1,988.00 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 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. -FlaPayee w4u�-(Z7N4 e� )" 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 $ K) $ ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# 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 20 Signatur Title Cost distribution ledger classification if claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Department of Workforce Development IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204 $1,950.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#!TITLE AMOUNT Board Members 1120 I I 41-100.00 I $1,950.00 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 NOV 1 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 'rescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL \n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by vhom, 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)) $1,950.00 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