The URL can be used to link to this page

238201 10/15/14 a�r_C�q� JY t� CITY OF CARMEL, INDIANA VENDOR: 359285 ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $"""'219.52' meq; CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 238201 y��ioN�° ANDERSON IN 46016 CHECK DATE: 10/15/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 REIMB 219.52 TRAVEL FEES & EXPENSE C 1 PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORE 110.101 11986) „ /i MILEAGE CLAIM )I2SJ6CAm�q`,,��1�(v (GOVEAKENTALUN1T1 `' `v` ON ACCOUNT OF APPROPRIATION NO. FOR (OYME,BOARD,DE?ARTUD"OR 1NS=TT10N) L DATE FROM TO SPEEDOMETERREADING +• AUTO MnXAGE zQ YETI POINTPORIT START FINISH NATURE OF BUSINESS TRAVELED C4 PER MILE Yin r_ I r—o C — --- —1 M C- - L.t. _ £ C, —1 Gc F6 c. W� 44kreqei- 'rc-teq L CC. G ch - -- -2 CL. 1'"-10 , -a` - - _��. M[rKfc) of CC I K& —OIL 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 due,after allowing all j czedits and that n part of the�s me has been paid, Date�� Df r.- -- I' ! 007 - 1 2014 OCT - 1 201' MSCRIDED BY SrATr BOARD OF ACCOURZ I GEN£AAL FORM 1/0.101(1986) r MILEAGE CLAIMTO— (GOVERNMENTAL URITq ON ACCOUNT OF APP P ATION NO. FOR (OF.ICE,BOARD,DEVART XXT OR 1NS[[TRTIONJ SPEEDOMETER DATE FROM TO READING + AUTO l4ILEAGE POINT POINT START FINISH NATURE OF BUSINESS TRAVELED ( �� PER MILE ILA rVIL CL t-D _ -o L —O£, I1/iCCr IG << WI CL � hn ru VrRisd v D� cc c 1 F —L G For F S11 FM M GL .3 -O I _ c r� `1—Lt AUTO LICENSE NO. TOTALS m 1 F 6�+ r U� 11 + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. C>tL1G 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 ue er aliowing all just cred' and that�o par}of the same has been paid., Date 9 f 0� I-q-g3g3°©� PRESCRIBED BY STATE BOARD OF ACCOUNTS ' A St �} GENERAL iOAL 110.101 11496) MILEAGE CLAIM �TO CJS (GOVERNMENTAL UNIT ON ACCOUNT OF APPROPRIATION NO. FOR (OF.ICE.BOARD.DEPARTMENT OR 1NSTMITION) SPEEDOMETER DATE FROM TO READING f. AUTO MILEAGE . POINT POINT START FINISH NATURE OF BUSINESS TRAVELED PER MILE b �/ 'V 4 CC "X—)) M IM C.0 -Il MG(. r G IL _ -- -1 c rA LL k (t -D FOIL SLC, - -- l rY1GC. Q, _ AUTO LICENSE NO. TOTALS GO 6 �� + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 3y, 0 YYYJJJ 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 aliowing just credits.- and that (o pari of the same has been paid. Date �✓��L � � l OCT - 204 PRTSCRIEED BY STATE BOARD OF ACCOUNTS \ c GENERAL FORM IIO.101(1986) S r- MILEAGE CLAIM ales LLCM V� J fV�4 ((3OVERNMENTALU 1'11 ON ACCOUNT OF APPROPRIATION NO. FOR tOF,M HOARD.DE?ARTMFNT OR TNSrM)TION) FROM TO SPEHDOMETEA� READING F AUTO MILEAGE DAiFFi �- POINT POINT START FINISH NATURE OF BUSINESS TRAVELED D C4 __ PER MILE l' Irv,Cr` C> 14i Ct fl'! �-T— �ICC -21 ' t C a 1r,;AMA 14 FOE CM Q Fof. 1E Lona- I I U. - - C:"Lnag r_ �c.. LL 1 - -t.� -D [C. AUTO LICENSE NO. TOTALS Z + 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 allow' an just credits,- and that n�(par4l I the same has been paid, Date V 1 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 9/29/14 Reimb Mileage 7/15- 9/29/14 $ 219.52 Total $ 219.52 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 i Voucher No. Warrant No.. 359285 Simmonds,Valeska Allowed 20 2703 E Lynn St Anderson, IN 46016 In Sum of$ $ . . 219.52 ON ACCOUNT OF.APPROPRIATION FOR 1.08 -ESE PO#or- Board Members INVOICE NO. ACCT#/TlTLE AMOUNT f Dept# i 1081-4 Reimb 4343000 $ 219.52 ;I 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 9-Oct ..2014 Signature $ 219.52 Accounts Payable Coordinator Cost distribution ledger classification if Title° claim paid motor vehicle highway fund