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Home My WebLink About233593 06/11/14 u% c,A,f. CITY OF CARMEL, INDIANA VENDOR: 359285 j; ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $*******316.40* 4 ,?q CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 233593 FM,�ioN ANDERSON IN 46016 CHECK DATE: 06/11/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 REIMB 316.40 TRAVEL FEES & EXPENSE JUN - 3 2014 PRESCRIBED B7 STATE BOARD OF ACCOUNTS , )�'-} "T• _ GENERALiO LNG.101(1986) MILEAGE CLAIM TO (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE,BOARD,DEPARTMENT OR INSTaUXION) --- SPEEDOMETER AUTOMILEAGEDATE FROM TO READING + NATURE OF BUSINESS MILES Q �`� TRAVELED Z8;—� POINT POINT START FINISH PER MILE Lencs. �� --- jNL �f a - �p r CU- -- U—Po V AA CC— A4 CL — 3 r-� - - m r- r--Ot 10 C-f- (KC-L.-.- AUTO LICENSE NO. TOTALS, + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 5q.3z. Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and correct,that the amount claimed is legally due,after allowing all just credits and that no a of th same has been paid. Date t7 71�.7 f , JUN --3 2014 PABSCRIBED BY STATE BOAAb OF ACCOUNTS I _�_Y. ERALiOAId 110.IUI IIVB61 MILEAGE CLAIM I C•l(��i SIM-�y4s• 61 gc- r fG" (OOVC]INHENTAL UNn1 ACCOU T F APPROPRIATION NO. FOR tOi710E,BOARD,DEPARTMENT OA INSM ULION) I• DATE FROM TO SREEDIO E TER AUTO WLEACE I NATURE OF BUSINESS MULES @ r POINT POINT START FINISH t TRAVELED PER MILE _ i 9 C4kn jC �i cc_ i •-1PA P. ' -0 C ., I e L I AUTO LICENSE NO. TOTALS + SPEEDOMETER READING columns are to be used only when distance between points cannot be delermin d by fix d j Ale4ge or oliScial highway.map. �JilI�JJ° Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing acci unt is ju aid correct,that the amount claimed is,legally due,after aliowin all just credits and that n art of the same has been paid. Date `� � f f � ' i JUN - 3 2014 PRESCRIBED BY STATE BOARD OF ACCOUNTS - t GFIffAIIL-FORN 110.101 11986] L / MILEAGE CL IM (GOVERNMENTAL lR1lr1 ACCOU 4T F A IPPROPRI ATION NO. FOR I (DEICE,BOARD.DEPARTmw on 1NSrnVriON) _ I SPEEDO DATE FROM To REE ETER I AUTO MILEAGE Z� I NATURE OF BUSINESS MILES ® r POINT POINT START FINISH TRAVELED PER WLE f V1 CL. & S a ` 1 '� r6NlCC � I � 1 =.p M CC- MCL b '1 b -1 -� I I . c CG I .a�y0 ticc ' � ! � W CL i ^L M CL I _ 2 I 7 AUTO LICENSE NO. TOTALS ��" q£)�,b2� + SPEEDOMETER READING columns are to be used only when distance between points cannot be determtn d by fix d W Ne4ge or official highway.map. m y i Pursuant to the provisions and penalties of Chapter 155,Acts 1853,I hereby certify that the foregoing accA unt is in az d correct,that the amount claimed is-legally due after allowing all ' t credits.- and that�lo ark of the same has been paid. Date L� r/ I . I JUN - 3 2014 PRESCRIPEO BY STATE BOARD OF ACCOUNTS GENERAL-FORM 110.101 119667 MILEAGE CL IM T Q ter (GOVERNMENTAL UNITI ACCOU T F APPROPRIATION NO. FOR (OMCE,HOARD,DEPABnaM OR tNSr=108) j FROM TO SPEEDO ER AUTO MMAGE BE ES A POINT POINT STAB? FINISH NATURE OF BUSINESS TRAVELED PER MILE q 15 MCCi i 1 —nndi -- � -- i i AUTO LICENSE NO, i TOTALS + SPEEDOMETER READING columns are to be used only when distance between points cannot be determin d by fix d I lije4ge or official highway map. y��!p i Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing acc uni is ju ai d correct,that the amount claimed is4egally due,after allowing all jiugAccredits and that no Part of the same has been paid. Date W25 / ANSM LI i i f JUiv Ll;t`P BY: PIVSCRIBCD BY STATE BOAPa OF ACCOUNTS I �t•� G MAL FORM 110.101 11906) MILEAGE CL IM o� T (GOVERNMENTAL UNIT? j ACCOU IT F APPROPRII ATION NO. FOR (OF.7CE,HOARD,DE}ARTIZWT OR INSTITUTION) i I DATE FROM TO SPEEDO ETERftEADI + I AUTO MILEAGE 2a- NATURE OF BUSINESS MILES Q a ., POINT POINT START FINISH TRAVELED PER MILE i e i u- r cc_ — et 41 WSC i CC 1*1blij Lo I i I / o A0 WMGC- e E �,0 C e I C(.. M CL C AUTO LICENSE NO. TOTALS + SPEEDOMETER READING columns are to be used only when distance between points cannot be determino d by ttx d i ifle4ge or ollicial highway.map. � Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby cart*that the foregoing acci unt is in aid correct,that the amount claimed is leg lly due,after allowing all st credits.- and that no arigof the same has been paid, Date �.a j JUN;- 3 2094 i � PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO.101(19B5) MILEAGE CLAIM L � CLAIM1 ! TO Cil `� uUU SLC" — (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE,BOARD,DEPART UM OR INSTITUTION) DATE FROM TO SPEEDOMETER READING + AUTO MILEAGE POINT POINT START FINISH NATURE OF BUSINESS1 MIL SLS p C PER I'm _ L cc CC 1 �- C.C. -v I mrf_ TC, ._. % I — c'-f MK 0 AUTO LICENSE NO. TOTALS 16 1 + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. -"I v-1 Pursuant to the provisions and penalties of Chapter 155,Acts 1953,1 hereby certify that the foregoing account is just and that the amount claimed is legall due,after aliowiaq all just or s: end that o alit of t e`same has been paid. Date �O` 6 vl y JUN - 3 2014 BY: 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. 359285 Simmonds, Valeska Terms 2703 E Lynn St Date Due Anderson,. IN 46016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO#. Amount 5/29/14 Reimb Mileage 1/13- 5/29/14 $ 316.40 Total $ 316.40 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 i Voucher No. Warrant No. I 359285 Simmonds, Valeska Allowed 20 2703 E Lynn St Anderson, IN 46016 J fIn Sum of$ $ 316.40 ON ACCOUNT OF APPROPRIATION FOR 108 -ESE I PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-4 Reimb 4343000 $ 316.40 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 I 5-Jun 2014 Signature $ 316.40 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I