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Home My WebLink About216552 01/28/2013 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $14,103.69 ie y''o CARMEL, INDIANA 46032 DEVELOPMENT ATTN ACCT RECV 10 N SENATE AVE CHECK NUMBER: 216552 INDIANAPOLIS IN 46204-2277 CHECK DATE: 1128/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 133438-00 680 . 00 FULL TIME REGULAR 1115 4110000 133438-00 12, 134 . 12 FULL TIME REGULAR 1207 4111000 133438-00 830 . 00 PART-TIME 1125 R4110000 29276 133438-00 459 . 57 UNEMPLOYMENT FEES • 1 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 CARMEL IN 46032-2584 REPORTING MONTH DEC, 2012 NETCHARGES $14, 103. 69 POSTING DATE JAN-04, 2013 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 opporturDity- 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 I ACQ CHARGED THIS 13 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 12/12 *** D M HEINZMAN JR 08/24/13 REG 12/12/12 12/08/12 390.00 *** 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: DECEMBER, 2012 Page 2 Employer Name: CITY OF CARMEL SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ CHARGED *** NEW CHARGES FOR THE REPORTING MONTH 12/12 *** G A PARK REG 12/09/12 05/28/11 284.00CR TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 05/11 : 284.00CR TOTAL AMOUNT OF NET CHARGES : 14,103.69 ti *** END OF BENEFIT CHARGE STATEMENT **** 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 Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 $680.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 41-100.00 ($880.00) I hereby certify that the attached invoice(s), or 1110 _ bill(s) is (are) true and correct and that the 1110 41-100.00 $1,560.00 materials or services itemized thereon for which charge is made were ordered and received except Thursday, January 24, 2013 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)) 01/04/13 unemployment charges-Park ($880.00) 01/04/13 unemployment charges- Herron $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 IN Department of Workforce Development Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 $830.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1207 I 133438-000 I 41-110.001 $830.00 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 Tuesday, January 22, 2013 Director, Brookshir Golf Club 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. i Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 01/04/13 I 133438-000 I Unemployment I $830.00 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 1/4/13 133438 Unemployment charges City Acct/Parks Dept Dec'12 $ 459.57 Total $ 459.57 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. 146500 ,Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204-2277 In Sum of$ $ 459.57 ON ACCOUNT OF APPROPRIATION FOR 101-General Fund PO#or INVOICE NO. ACCT#/ AMOUNT Board Members Dept# TITLE 29276 133438 4110000 $ 459.57 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 24-Jan 2013 Signature $ 459.57 Accounts Payable Coordinator Cost distribution ledger classification if Title 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. `1/�/� Payee f 1' tl ' �� ` l� �� Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) ca � 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 $ 1� �ka- $ 109 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 ( 0 Ob 1 -)-bill(s) is (are) true and correct and that the IZ" ,rj materials or services itemized thereon for ZQ l Lp D C 0 t) which charge is made were ordered and 1 b 4110006 L)U received except 20 Signatu Title Cost distribution ledger classification if claim paid motor vehicle highway fund