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Home My WebLink About226021 11/07/2013 i CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $1,738.99 CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV 10 N SENATE AVE CHECK NUMBER: 226021 INDIANAPOLIS IN 46204-2277 CHECK DATE: 11/7/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 133438 - . 58 OTHER EXPENSES 1120 4110000 133438 1, 765 . 00 FULL TIME REGULAR 1125 4111000 133438 -5 . 29 PART-TIME 1301 4110000 133438 -20 . 14 FULL TIME REGULAR - - - - - - - - - - - - - - - - - - - - - - - - -- -- ---- ------ The following items apply to your benefit ACCOUNT NUMBER: 133438 charges posted in OCTOBER of 2010 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD ....................................... ....................................... PREVIOUS BALANCE .00 .00 .00 -REVERSAL OF BENEFIT CHARGES 20.14CR -PAYMENT ADJUSTMENTS 20.14 .00 .00 ENDING BALANCE .00 i .00 .00 .00 The following items apply to your benefit charges posted 'in MAY of 2011 ACCOUNT NUMBER: 133438 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD ....................................... ....................................... ....................................... ........................................ PREVIOUS BALANCE .00 .00 .00 -REVERSAL OF BENEFIT CHARGES 5.29CR J T =PAYMENT_AD US MENTS- 5.29 .05 .,� ADJUSTMENT OF INTEREST PENALTY 05CR 53CR ........................................ ENDING BALANCE .00 i .00 i .00 .00 THE TOTAL LIABILITY BALANCE IS LOCATED ON THE LAST PAGE OF THIS BILL. ***************** Additional interest will accrue at a rate of 1% per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If the liability is not paid in full, the Director may file with the clerk of the circuit court in your county, a warrant directing the sheriff to levy upon assets, in sufficient quantity to satisfy the amount of the warrant plus damages in the amount of 10%, plus penalties and interest. If you have any questions, please call (800) 891-6499 or (317) 232-7395 and ask for Collections. I • The following items apply to your benefit ACCOUNT NUMBER: 133438 charges posted in SEPTEMBER of 2013 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD ....................................... ...................................... ....................................... PREVIOUS BALANCE 1,194.66 .00 .00 PAYMENTS 1 168.65CR 00 00 PAYMENT ADJUSTMENTS 26.01CR 00 .00 ENDING BALANCE .00 i .00 .00 .00 The following items apply to your benefit ACCOUNT NUMBER: 133438 I es posted in OCTOBER of 2013 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR'THE PERIOD PREVIOUS BALANCE 00 .00 00 -ASSESSMENT OF BENEFIT CHARGES 1,765.00 -PAYMENTS 26.01CR .00 .00 ENDING BALANCE i 1,738.99 1 .00 .00 1 1,738.99 THIS IS YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $1 , 738. 99 PAY THIS AMOUNT NO LATER THAN..........NOVEMBER 30, 2013 Additional interest will accrue at a rate of 1% per month and a one time penalty of 10% will be assessed on any outstanding benefit charges after the payment due date. If the liability is not paid in full, the Director may file with the clerk of the circuit court in your county, a warrant directing the sheriff to levy upon assets, in sufficient quantity to satisfy the amount of the warrant plus.damages in the amount of 10%, plus penalties and interest. If you have any questions, please call (800) 891-6499 or (317) 232-7395 and ask for Collections. 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 SEP, 2013 CARMEL IN 46032-2584 NETCHARGES $1, 739.57 POSTING DATE OCT-04 , 2013 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment-insu►ante 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 SECURITY YEAR END CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE I 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 (Foam 1067) for these charges and any previous liability still outstanding. *** NEW CHARGES FOR THE REPORTING MONTH 09/13 *** R S LANNAN 04/26/14 REG 09/29/13 09/28/13 353.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 09/13 1,765.00 *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 04/11 *** K L NEFOUSE 02/11/12 REG 09/25/13 04/02/11 ---------5 29CR {'G� TOTAL REVERSED. CHARGES/CREDIT FOR THE PRIOR MONTH 04/11 5.29C , f *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 09/10 *** D A HUGHES 08/20/11 REG 09/12/13 09/18/10 --------20�14CR TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 : 20.14CR TOTAL AMOUNT OF NET CHARGES : 1,739.57 *** 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 Lit �cc �im Purchase Order No. T Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 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. I ALLOWED 20 L IN SUM OF $ lvl ()�dS �j 4& q �-1'7 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 �?�C (/o1)Op �,7� � materials or services itemized thereon for 't111000 —�j, 6 which charge is made were ordered and 18(0'L'Z)P- •l received except 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund