HomeMy WebLinkAbout240114 12/09/14 CITY OF CARMEL, INDIANA VENDOR: 359285
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $"""****214.20"
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 240114
9Mli0N, ` ANDERSON IN 46016 CHECK DATE: 12/09/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 214.20 TRAVEL FEES & EXPENSE
i
PRESCRIBED BY STATE BOARD OF AOCOUHrS GENERAL FORM 110.IBI(1486)
MILEAGE CLAIM I c c
TO
(GOVERNMENTAL UNIT(
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,HOARD,DEF&RTMEHT OR INSr=ION)
�DA FROM TO SPEEDOMETER AUTO MILEAGE
READING t
POINT POINT START FINISH NATURE OF BUSINESS TRAVEL D 9
PER MILE
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AUTO LICENSE NO. — TOTALS vr�
+ 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 e,after allowing all ju credits
and that no part of the saa has been paid.
Date
� I
L
NOV 2``4 2014
B_Y:
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PRESCRIBED B7 STATE BOARD OF ACCOUNTS \ GENERAL FOAL 110.101(1980
MILEAGE CLAIM
IIDNMENTAL UN1TI ON ACCOUNT OF APPROPRIATION NO. FOR
(OFF7Cr,BOARD,DEPAMM"OR INSUTUTION)
AM1nt1 FROM TO SPEEDOMETER
V ti-- F READING .f. AUTO MILEAGE
ES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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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 lggp� dv after allowing all just credits
and that no part of the same has been paid. U
Date L(
N 0 V 2:4 2614
1 BY:
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORf1110.1010"6)
MILEAGE CLAIM `�R S�
ro --T` � <YYJc1Gk/C
IOOVE3INMENTAL UN1T1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF.ICE,BOARD,DEPAATW NT OR 1NnT nITION)
DATE FROM TO SPEEDOMETER '
�--L READING .r AUTO IIILEAOE
pOiNT POINT START FINISH NATURE OF BUSINESS TRAVELED
_ PER MILE
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AUTO LICENSE NO_ TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between polats 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 amcunt claimed is le ally due,after allowing all j r
and That
no part/of the same has been paid.
Date
r � N0V i74 2014
I
I II
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FONf1110.101(1986)
_ MILEAGE CLAIM
(GovERA 1ENrAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEP"TWU(T Op INSr(T=Jox)
DATE FROM i TO SPEEDOMETER READING + AUTO MILEAGE
VMILES a
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
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10
i. AUTO LICENSE NO. TOTALS I 5U. 5V
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. ��V++ 1�V�
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 edits'.
and that/n�part of the same has been paid. i
Date 'V , Ll 1
F NOV 2:4 2014
,n
�c I ' �Y.
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
11/21/14 Reimb Mileage 9/29- 11/21/14 $ 214.20
Total $ 214.20
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 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 j
In Sum of$
$ 214.20
1
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 214.20 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
3-Dec 2014
I
r
t Signature
$ 214.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund