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Home My WebLink About217521 02/25/2013 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 �•�t0 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $15,330.14 ,?o CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV «o� 10 N SENATE AVE CHECK NUMBER: 217521 INDIANAPOLIS IN 46204-2277 CHECK DATE: 2/25/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 133438-000 1, 246 . 00 FULL TIME REGULAR 1115 4110000 133438-000 10, 921 . 31 FULL TIME REGULAR 1207 4111000 133438-000 2 , 382 . 00 PART-TIME 1301 4110000 133438-000 -20 . 14 FULL TIME REGULAR 1125 R4110000 29276 133438-000 800 . 97 UNEMPLOYMENT FEES 133438 -1 CEUVED INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT FEB 2 0 2013 BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE,INDIANAPOLIS,IN 46204-22 7 Toll free 1-800.891-6499 Marion County 232-7436 �Y;—� _— ----. - 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 LOCATIONNUMBER 133438 -000 ONE CIVIC SQ CARMEL IN 46032-2584 REPORTING MONTH JAN, 2013 i NET CHARGES $15, 330, 14 POSTING DATE FEB-01 , 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 opportunity,, and the responsibility to report any information which could disqualify the claimant.. SOCIAL BENEFIT PAID FOR i 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 (Farm 1067)for these charges and any previous liability still outstanding. *** NEW CHARGES FOR THE REPORTING MONTH 01/13 *** P D GORDON �� 11A 08/31/13 REG 01/10/13 01/05/13 390.00 *** CONTINUE ON NEXT PAGE **** An (*) in the ACO column denotes a charge resulting from an acquisition of another business. Account/Lo,ation Number: 133438 -000 Reporting Month: JANUARY, 2013 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 ACO CHARGED *** NEW CHARGES FOR THE REPORTING MONTH 01/13 *** D A HUGHES 08/20/11 REG 01/03/1.3 09/18/10 20.14CR --------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 20.14CR TOTAL AMOUNT OF NET CHARGES 15,330.14 0140 1 n END OF BENEFIT CHARGE STATEMENT An (*) in the ACCT column denotes a charge resulting from an acquisition of another business. 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 2/1/13 133438 Unemployment charges City Acct/Parks Dept Jan'l3 $ 800.97 Total $ 800.97 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$ $ 800.97 ON ACCOUNT OF APPROPRIATION FOR 101-General Fund PO#or INVOICE NO. ACCT#/ AMOUNT Board Members Dept# TITLE 29276 133438 4110000 $ 800.97 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 21-Feb 2013 Signature $ 800.97 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund 2° V� �i �� vo Coo S� Z� o do Comm 1,950.00 1,950.00 1,343.29 1,560.00 1,950.00 1,560.00 608.02 800.97 11,722.28 Police 1,950.00 (704.00) 1,246.00 Golf 369.00 11-665.00 348.00 2,382.00 Court (20.14) (20.14) 15,330.14 VOUCHER NO. WARRANT NO. ALLOWED 20 IN Department of Workforce Development Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 $2,382.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1207 I 133438 I 41-110.00 I $2,382.00 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 + (� ` j (U DU r '' which charge is made were ordered and received except Wednesday, February 20, 2013 A 94 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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/01/13 133438 Unemployment $2,382.00 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