HomeMy WebLinkAbout235203 07/22/14 +�,CAq�
� F CARMEL INDIANA
VENDOR: 359285
�, CITY O CH OUNT: $*******217.28*
�= �• CIVIC SQUARE VALESKA SIMMONDS
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CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 235203
''�r:o„�� ANDERSON IN 46016 CHECK DATE: 07/22/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 217.28 TRAVEL FEES & EXPENSE
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FBESCRIBBD BY STATE BOARD OF ACCOUNTS
GENERAL FORM NO,101(IM)
MILEAGE CL o— �ImCq
/.% U+�XS
� TO— I l
-- L.r (GOVERNMENTAL UNIT) r
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTIQNT OR IMSTRVTIoNj
DATE
FROM TO SPEEDOMETER
READG + AUTO MILEAG
IN
k POINT POINT START FINISH NATURE OF BUSINESS TRAVELED D ® ` o
PER MILE
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AUTO LICENSE NO. TOTALS o 1
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and correct,that(theamount claimed is le ally due,after aliowin H just credits.
end that no part of the same has been paid.
Date
F77
I 'JUL 14 20111 ` f
f
PRESCRIBED By STATE HOARD OF ACCOUNTS GENERAL FORM NO.101(1086)
MILEAGE CLAIM m
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR Ui5'TRUI ON)
DATE
FROM TO SPEEDOMETER
READING -( AUTO MILEAGE
- POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER DIU.E
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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.
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 le ally due,after allowing all f t Credits,-
end
redits:and that no part of the same has been paid. �II
Date Co-1 LD" k! V
�� JUL - 11t I ��
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PRESCRIBED MY STATE BOARD OF ACCOUNTS I GM41M L FORM NO.101(1906)
MILEAGE CLAIM
ss TOda(el" �I�Li' • '�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTNINT OR INMTUTI0L7
DATE FROM TO SPEEDOMETERREADING { AUTO MILEAGE
POINT POINT START FINISH NATURE OF BUSINESS TRAVVELED a ,
PER MII,S
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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.
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 d ,after aliotviTtg all st credits;
end thatn�pgl t J the same has been paid.
Date b'/ —7
3' --
JUL 14 2014
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
7/14/14 Reimb Mileage 6/2-7/14/14 $ 217.28
Total Is 217.28
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.
r
359285 Simmonds,Valeskai Allowed 20
2703 E Lynn St
Anderson, IN 46016
1,'In,Sum of$
$ 217.28
ON ACCOUNT OF APPROPRIATION FOR �
108 -ESE
PO#.or INVOICE NO. ACCT#/TlTLE AMOUNT Board Members
Dept#
1082-10 Reimb 4343000 $ 217.28 I hereby certify that the attached invoice(s), or
bill(s)is(are)true and correct and that the
l materials'or services itemized thereon for
which charge is made were ordered and
received except
I
16-Jul 2014
Signature
$ 217.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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