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Home My WebLink About219148 04/18/2013 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 0 ` ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CARMEL, INDIANA 46032 DEVELOPMENT ATTN.ACCT RECV CHECK AMOUNT: $10,425.35 10 N SENATE AVE CHECK NUMBER: 219148 INDIANAPOLIS IN 46204-2277 CHECK DATE: 4/18/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 76 . 00 FULL TIME REGULAR 1115 4110000 9, 503 . 35 FULL TIME REGULAR 1207 4111000 846 . 00 PART-TIME 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 MAR, 2013 NETCHARGES $10 ,425. 35 POSTING DATE APR-05, 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 ew:picyer had-the opportunity--- - - and'thb responsibility to report any information which could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM RANSACTION 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 03/13 *** J C HERRON ,\il 08/31/13 REG 03/11/13 03/09/13 390.00 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: MARCH, 2013 Page 2 Employer Name: CITY OF CARMEL SOCIAL I BENEFIT PAID FOR SECURITY I YEAR END CLAIM RANSACTION WEEK AMOUNT NUMBER I EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACO CHARGED *** NEW CHARGES FOR THE REPORTING MONTH 03/13 *** D M HEINZMAN JR 08/24/13 REG 03/25/13 03/23/13 ` 390.00 --------------- TOTAL NEW CHARGES FOR THE REPORTING MONTH 03/13 11,129.35 *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 07/11 *** G A PARK 02/18/12 REG 03/24/13 07/16/11 368.000R TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 07/11 : 704.00CR --------------- --------------- TOTAL AMOUNT OF NET CHARGES 10,425.35 *** END OF BENEFIT CHARGE STATEMENT **** An (*) in the ACQ column denotes a charge resulting from an acquisition of another business. 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 �I 4eteo — Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) ' J v 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 ,J--d' - �c� IN SUM OF $ S L- 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 Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 IN Department of Workforce Development Benefit Administration IN SUM OF $ 10 North Senate Avenue Indianapolis, IN 46204-2277 $846.00 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 I 133438-000 I 41-110.00 I $846.00 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 Thursday, April 18, 2013 Director, 13=0 4e e 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)) 04/05/13 133438-000 Unemployment Charges $846.00 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 $76.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1110 41-100.00 ($704.00) I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1110 ----4-1---1,00.00 $780.00 materials or services itemized thereon for which charge is made were ordered and received except Thursday, April 18, 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)) 04/05/13 unemployment charges- Park ($704.00) 04/05/13 unemployment charges- Herron $780.00 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