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Home My WebLink About223355 08/26/2013 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $1,381.71 ,? CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV 10 N SENATE AVE CHECK NUMBER: 223355 INDIANAPOLIS IN 46204-2277 CHECK DATE: 8/26/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4110000 133438-000 -25 . 00 FULL TIME REGULAR 1120 4110000 133438-000 1, 412 . 00 FULL TIME REGULAR 1125 4110000 133438-000 -5 . 29 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 SQ REPORTING MONTH JUL, 2013 CARMEL IN 46032-2584 NET CHARGES $1 , 381. 71 POSTING DATE AUG-02 , 2013 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment-�insurarice-sinIce, -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 SECURITY YEAR END I CLAIM WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING A 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 07/13 *** R S LANNAN 04/26/14 REG 07/29/13 07/27/13 353.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 07/13 1,412.00 *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 09/11 *** G A PARK 02/18/12 REG 07/22/13 09/03/11 25.ODCR ---------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/11 25-OOCR *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 04/11 *** K _L NEFOUSE 02/11/12 REG 07/08/13 04/02/11 5.29C --------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 04/11 5.29CR TOTAL AMOUNT OF NET CHARGES 1,381.71 *** END OF BENEFIT CHARGE STATEMENT **** An {*) in the ACO 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.7995) 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. Payees/ Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) I2 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. l ALLOWED 20 (/M:IN SUM OF $ $ PAS . ON ACCOUNT OF APPROPRIATION FOR wa� .slid - (,a ��•2,; L�g�v� I/Y, +�,-,. 1 Board Members PO#or ,INVOICE NO. ACCT`I#/TTIIiTLEAMOUNT DEPT.# I hereby certify that the attached invoice(s), or 0 ( p a Q a-� bill(s) is (are) true and correct and that the materials or services itemized thereon for 0 ' Q��!� S which charge is made were ordered and L /� received except l1- I V �r 'rc 20 Signature Cost distribution ledger classification if Title 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 $1,412.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I I 41-100.00 I $1,412.00 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 AUG 2 6 2013 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 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)) $1,412.00 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