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Home My WebLink About226884 12/10/2013 F CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CHECK AMOUNT: $1,352.70 s s.+ CARMEL, INDIANA 46032 DEVELOPMENT ATTN:ACCT RECV �ti,rod.0 10 N SENATE AVE CHECK NUMBER: 226884 INDIANAPOLIS IN 46204-2277 CHECK DATE: 12/10/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 133438 —3 . 87 OTHER EXPENSES 1110 4110000 133438 —30 . 00 FULL TIME REGULAR 1120 4110000 133438 1, 412 . 00 FULL TIME REGULAR 1125 4110000 133438 —5 . 29 FULL TIME REGULAR 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 7.39CR PAYMENT ADJUSTMENTS 7.39 .00 00 ENDING BALANCE .00 i .00 .00 .00 The following items apply to your benefit charges posted in NOVEMBER of 2010 ACCOUNT NUMBER: 133438 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE .00 .00 .00 -REVERSAL OF BENEFIT CHARGES 12.75CR PAYMENT ADJUSTMENTS- 12.7c s00, .00 ENDING BALANCE .00 i .00 i .00 1 .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. The following items apply to your benefit charges posted in MAY of 2011 1 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 -PAYMENT ADJUSTMENTS 5.29 .05 52 ADJUSTMENT OF INTEREST PENALTY / 05CR 52CR ENDING BALANCE .00 .00 .00 .00 The following items apply to your benefit ACCOUNT NUMBER: 133438 charges posted in OCTOBER of 2011 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE 00 .00 .00 -REVERSAL. OF BENEFIT CHARGES 30.000R -PAYMEN ADJUSTMENTS 3C.00 z _0 3.00 -ADJUSTMENT OF INTEREST PENALTY / .30CR 3.000R <z ENDING BALANCE 00 .00 1 .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 f REIMBURSABLE BILL ACCOUNT NUMBER: 133438 PAGE: 3 OF 3 DATE: DECEMBER 01 , 2013 The following items apply to your benefit charges posted in OCTOBER of 2013 ACCOUNT NUMBER: 133438 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE .00 .00 1,738.99 -PAYMENTS 1 679.69CR .00 .00 PAYMENT ADJUSTMENTS 59.30CR 00 .00 ENDING BALANCE .00 .00 .00 .00 The following items apply to your benefit ACCOUNT NUMBER: 133438 charges posted in NOVEMBER of 2013 ACTIVITY SUMMARY BENEFIT CHARGES INTEREST PENALTY TOTAL LIABILITY FOR THE PERIOD PREVIOUS BALANCE .00 .00 .00 CHARGES 1 ASSESSMEN T OF BENEFIT ARGE ,412.00 — -PAYMENTS_ S .30.R .00 ;;:.;;;:::.;:....:... ENDING BALANCE 1 1,352.70 .00 .00 11352.70 THIS IS YOUR TOTAL LIABILITY. PAYMENTS MAILED AFTER THE 20TH OF THE MONTH MAY NOT BE REFLECTED ON THIS BILL. PLEASE $1, 352 . 70 PAY THIS AMOUNT NO LATER THAN..........DECEMBER 31, 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 OCT, 2013 CARMEL IN 46032-2584 NETCHARGES 1 $1 , 356. 57 POSTING DATE NOV-01, 2013 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for --_ Linernplo%lment-in ,;--.,!a ce since, before any-payments were,made the employer had the opportunity and the responsibility to report any information which could disqualify the claimanf. SOCIAL BENEFIT PAID FOR SECURITY YEAR END CLAIM WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE ENDING ACQ 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 10/13 *** R S LANNAN 04/26/14 REG 10/27/13 10/26/13 353.00 --------------- TOTAL NEW CHARGES FOR THE REPORTING MONTH 10/13 1,412.00 *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 09/11 *** G A PARK 02/18/12 REG 10/09/13 09/03/11 30.00CR --------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/11 30.00CR *W* REVERSED-CHARGES/CREDI FOR THE PRIOR MONTH 04/11 *** K L NEFOUSE .� 02/11/12 REG 10/08/13 04/02/11 5.29C ------------- TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 04/11 5.29CR IK *** REVERSED CHARGES/CREDITS FOR THE PRIOR MONTH 10/10 *** D A HUGHES 08/20/11 REG 10/01/13 09/25/10 --------12�75CR TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 10/10 : 12.75CR *** REVERSED CHARGES/CREDITP FOR THE PRIOR MONTH 09/10 *** D A HUGHES 08/20/11 REG 10/01/13 09/18/10 7.39CR 1 / TOTAL REVERSED CHARGES/CREDIT FOR THE PRIOR MONTH 09/10 : 7.39CR `� --------------- --------------- TOTAL AMOUNT OF NET CHARGES : 1,356.57 *** 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 �' ►✓ Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) L 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 IN SUM OF $ Avt ��l b� ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or ( w Z— bill(s) is (are) true and correct and that the 7j1 � materials or services itemized thereon for i ( v �j: Zc, which charge is made were ordered and 72 p 4.33 411 bi)b -Q--75 received except of 4-t(0DVL—)--7,� i -�9 �5� 3 9� 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund