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216988 02/07/2013 CITY OF CARMEL, INDIANA VENDOR: L2370 Page 1 of 1 ONE CIVIC SQUARE I N S C C U-ASFE CHECK AMOUNT: $220.00 CARMEL, INDIANA 46032 PO BOX 6271 INDIANAPOLIS IN 46206-6271 CHECK NUMBER: 216988 CHECK DATE: 2/7/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 CITYOFCARMEL 220 . 00 CHILD SUPPORT FEES ®rder t® Withhold Income s for the 2012 Indiana annual Support Fee Indiana Department of Child Services State Child Support Bureau Per Indiana Statutes IC-33-373-6 and IC-31-16-15 - #BWNNXZL 11/14/2012 #9781 9996 43R# CITY OF CARMEL ONE CIVIC SQUARE ATTN KAREN HUFFMAN CARMEL IN 46032 1 This is an Order to Withhold Income for the 2012 Annual 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. • Pavine 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. • Payinp,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. For more - iniorrnaiiun wncerning Lhis process,please cai iii=i3%-ui27 or i-8u`v'-2y%=v4ui,option 1 - s 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 INSDU 1 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 EMUADCS.IN.gov.. SIGNATURE Cynthia Longest Deputy Director Department of Child Services Child Support Bureau 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: INSCCU - 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 Worked or Due Paying Never Employed per case per case NA A R RETTE ?1 T ANT $55.170 #BWNNXZL #0006 2955 08U# DONALD D. SCHOEFF 10138 N PARK AVE INDIANAPOLIS IN 46280-1618 - -- Mo PLEASE RETAIN THIS PAGE FOR YOUR RECORDS COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT 29D01-0811-DR-1476 $55.00 Total ASFE Due for the above listed cases $55.00 Promclii7g our childnw,.piwilits and.firlure Michael R.Pence,Governor John P Ryan,Director Indiana Department of Child Service Child Support Bureau MS 11 s a. 402 W.Washington Street Indianapolis,Indiana 46204-2739 317-233-5437 FAX:317-233-4925 wwwin.gov/dcs Child Support Hotline:800-840-8757 01/19/2013 Child Abuse and Neglect Hotline:800-800-5556 ANNUAL SUPPORT FEE NOTICE The Indiana General Assembly set the amount of the Annual Support fee at$55.00,effective January 1, 2008. Employers please note: In instances where the Child Support Bureau does not have the address of the non-custodial parent (NCP), this notice is sent in the care of the NCP's last known employer. Employers are asked to forward this notice to your employee, or inform the Child Support Bureau if the non-custodial parent is no longer employed with your company. Dear DONALD D. SCHOEFF, This notice is to inform you that pursuant to 1C 33-37-5-6 and IC 31-16-15, the 2013Annual Support and Maintenance Docket Fee (ASFE) for the listed child support case(s) shown below is due by 06/30/2013. The $55.00 fee is due for each and every individual case. In order to assure proper credit, you must include the coupon on the bottom of this notice with your payment. In addition please remember to write on your check or money order the 1SETS case number(s) listed on the coupon and clearly note that the payment is for the ASFE. DO NOT COMBINE your ASFE payment with a child support payment or you may not receive proper credit for the payment of this fee. This is the only notice you will receive for this year's fee, this calendar year. if the total amount shown is not received by 06/30/2013,an Income Withholding Order will be sent to your employer to withhold the balance owed for the current year's fee for each and every individual case eligible for income withholding. If you have any questions about this notice,please contact the hidsline at (317)233-5437 or (800)840-8757. Please note: you may also receive an ASFE notice from your County Clerk's office regarding any past due ASFE balances from previous years. Please contact the County Clerk about those notices. Thank you Indiana State Child Support Bureau Department of Child Services - #BWNNXZL - #0003 4540 66C# AARON HOOVER C/O CITY OF CARMEL ONE CIVIC SQUARE ATTN KAREN HUFFMAN ARMEL IN 46032 PLEASE RETAIN THIS PAGE FOR YOUR RECORDS COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT 29D01-9810-DR-0614 $55.00 Total ASFE Due for the above listed cases $55,00 Prol(,a i our chilcli°efr,farir✓lier and figure Michael R.Pence,Governor John P.Ryan,Director Indiana Department of Child Service Child Support Bureau MS]1 r D 402 W.Washington Street Indianapolis,Indiana 46204-2739 317-233-5437 r FAX:317-233-4925 www.in.gov/dcs Child Support Hotline:800-840-8757 01/19/2013 Child Abuse and Neglect Hotline:800-800-5556 ANNUAL SUPPORT FEE NOTICE The Indiana General Assembly set the amount of the Annual Support fee at$55.00, effective January 1, 2008. Employers please note: In instances where the Child Support Bureau does not have the address of the non-custodial parent (NCP),this notice is sent in the care of the NCP's last known employer. Employers are asked to forward this notice to your employee, or inform the Child Support Bureau if the non-custodial parent is no longer employed with your company. Dear AARON HOOVER, This notice is to inform you that pursuant to IC 33-37-5-6 and 1C 3 1-16-15, the 2013Annual Support and Maintenance Docket Fee (ASFE) for the listed child support case(s) shown below is due by 06/30/2013. The$55.00 fee is due for each and every individual case. In order to assure proper credit,you must include the coupon on the bottom of this notice with your payment. In addition please remember to write on your check or money order the 1SETS case number(s) listed on the coupon and clearly note that the payment is for the ASFE. DO NOT COMBINE your ASFE payment with a child support payment or you may not receive proper credit for the payment of this fee. This is the only notice you will receive for this year's fee, this calendar year. If the total amount shown is not received by 06/30/2013,an Income Withholding Order will be sent to your employer to withhold the balance owed for the current year's fee for each and every individual case eligible for income withholding. If you have any questions about this notice,please contact the Kidsline at (317)233-5437 or (800)840-8757. Please note: you may also receive an ASFE notice from your County Clerk's office regarding any past due ASFE balances from previous years. Please contact the County Clerk about those notices. Thank you Indiana State Child Support Bureau Department of Child Services #BWNNXZL #0004 3532 46E# JOHN W. MCALLISTER C/O CITY OF CARMEL ONE CIVIC SQUARE ATTN KAREN HUFFMAN ARMEL IN 46032 S PLEASE RETAIN THIS PAGE FOR YOUR RECORDS COURT CAUSE NUMBER ISETS CASE NUMBER ASFE AMOUNT 29C01-0205-JP-0684 $55.00 Total ASFE Due for the above listed cases $55.00 Prwertina our children,families and fitture �4. Michael R.Pence,Governor John P Ryan,Director Indiana Department of Child Service Child Support Bureau ' MSII 0 402 W.Washington Street Indianapolis,Indiana 46204-2739 317-233-5437 FAX.317-233-4925 www.in.gov/dcs (hild Support Hotline:800.840-8757 01/19/2013 (hild Abuse and Neglect Hotline:800-800-5556 ANNUAL SUPPORT FEE NOTICE The Indiana General Assembly set the amount of the Annual Support fee at$55.00, effective January 1, 2008. Employers please note: In instances where the Child Support Bureau does not have the address of the non-custodial parent (NCP),this notice is sent in the care of the NCP's last known employer. Employers are asked to forward this notice to your employee, or inform the Child Support Bureau if the non-custodial parent is no longer employed with your company. Dear JOHN W. MCALLISTER, This notice is to inform you that pursuant to IC 33-37-5-6 and IC 31-16-15, the 2013Annual Support and Maintenance Docket Fee (ASFE) for the listed child support case(s) shown below is due by 06/30/2013. The $55.00 fee is due for each and every individual case. In order to assure proper credit, you must include the coupon on the bottom of this notice with your payment. In addition please remember to write on your check or money order the ISETS case number(s) listed on the coupon and clearly note that the payment is for the ASFE. DO NOT COMBINE your ASFE payment with a child support payment or you may not receive proper credit for the payment of this fee. This is the only notice you will receive for this year's fee, this calendar year. If the total amount shown is not received by 06/30/2013, an Income Withholding Order,ill be sent to your employer to withhold the balance owed for the current year's fee for each and every individual case eligible for income withholding. If you have any questions about this notice, please contact the Kidsline at (317)233-5437 or (800)840-8757. Please note:you may also receive an ASFE notice from your County Clerk's office regarding any past due ASFE balances from previous years. Please contact the County Clerk about those notices. Thank you Indiana State Child Support Bureau Department of Child Services 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. Payee Z/")-.5 C' C 6 , Purchase Order No. �� ✓ 4'1�' 7/ Terms 14 ;2 6'oZ-71 Date Due Invoice Invoice Description Amount Date Number / (or note attached invoice(s) or bill(s)) AC Al 0-V 9P 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 /I✓`SCG `l -K�1� IN SUM OF $ 110d 71 ,&,// //U/ t,�? 71 $ Sao:vv ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or /%/0 , -5SOe� received except l- 20 ,/9 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund