246532 06/17/15 .i ""*�, CITY OF CARMEL, INDIANA VENDOR: 359285
.I; ® �,• ONE CIVIC SQUARE VALESKA SIMMONDS
CHECK AMOUNT: $*******448.60*
x =� CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 246532
9�` ANDERSON IN 46016 CHECK DATE: 06/17/15
[TON G�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 448.60 TRAVEL FEES & EXPENSE
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENFAAL FORE IIO.101(1986)
EMILEAGE CLAIM eC �Mor�S
� J (�
(GovEAN►IENrAt 11NI'[)
ON ACCOUNT OF APPROPRIATION NOt FOR
tOPFICE,BOARD.DEPT@ r OR INSrMTPION)
R
DATE FROM TO SPEEDOMETEAUTO tI
READINGG .,-
POINT POINT START FINISH NATURE OF HUSINE56
-1F—UL-
ITAAVELED PER MILE
LF _p o ,fro
OAC C
tC
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AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. '$
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is-jusLand correct,that the amount claimed is legally due,after allowing all jus credits
and that rt oiosaa has b
Date �- �
JUN - 2 2015 �:
PRMCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FOAL 110.101(1986)
MILEAGE CLAIM
L SE. TO
(GOVERNMENTAL UNIT)
' ON ACCOUNT OF APPROPRIATION NO., FOR
(OPTICE,HOARD,DEPAATXE)rr OA INSTITUTION)
SPEEDOMETER
D TE FROM TO READING + AUTO MILEAGE
t POINT POINT START FINISH NRTURE OF BUSINESS TRAVELS
PER MILE
F
Pnf me 471-V
1 -`0f
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AUTO LICENSE NO. TOTALS J0 1a` OZ—
+ SPEEDOMETER READING colurans are to be used only when distance between points cannot be determined by fixed mileage or official highway map. A foq't 5R
1
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing accountis_just and correct, that the amount claimed is legally due,after allowing all j
and that no pr-art of the same has been paid.
Date 15
JUN - 2 2015
----------__------\�L�� -fib
i
PRESCRIBED BY STATE BOARD OF ACCOIIN75 ` GENERAL FOAM 110.101(1986)
MILEAGE CLAIM
SE To
(OOVERNMENrAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(O"CE,BOARD,DEPART@(}OR 1NSTITUrION)
SPEEDOMETER
DAT FROM TO READING + NATURE OF BUSINESS MMES Q "n vAGE
'�]]� POINT POINT START FINISH TRAVELED PER MRS �� 65
LL 9
MCC-
r-0 If
F-
C-L- rnu<
=0 Twl ti CL61_4 =�
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rt) er
ry Z= c�
j ._..�
t _
a-to —
.r .
MCC
AUTO LICENSE NO. TOTALS F,
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. c 5
t
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account is just and correcf�!ha!-the-amelinLclaimed is legally due,after alio ing al .usl credits,-
and
redits.-and that no part of the same has been paid, 1
Date ~�✓
JUN - 2 2015
y
PRFSCRIEED BY STATE BOARD OF ACCOUNTS GENERAL FOAM 110.101 VU53
_ MILEAGE CLAIM V��� McS
(GOVERNMENTAL UUM
ON ACCOUNT OF APPROPRIATION NO. FOR
LOP-IM BOARD.DEPAATWNr OR INSTITUTION!
�DATE FROM TO SPEEDOMETERREADING + AUTO MILEAGE c
+1�3 POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
r 1 _ PER MILE
4/ Gl An
15 1 '•Tat rAC( _
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1, m
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WL
a
94) a5 1 11 am.MCLO 11 C— ,�,, C .
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r� MCC
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AUTO LICENSE NO. TOTALS O c V*
+ SPEEDOMETER READING columns are to be used cnly when distance between poluts 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 aliowing all j t credits,
and that no
part of the same has been paid.
Dale
JUN - 2 2015
'��V
PRESCRIBED B7 STATE BOARD Of ACCOUNTS
'� GENERAL FORE 110.101 11906)
c.i+ MILEAGE CLAIM
TO
1GOVERNMENTAL IIN1T)
ON ACCOUNT OF APPROPRIATION NO- FOR
IOMCE,BOARD,DEIARTWEKT OB INS'nJON)
DATE FROM TO –— SPEEDOMETER AUTO MILEAGE
READING .f
POINT POINT START FINISH NATURE OF BUSINESS 1'MILES a
D f
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AUTO LICENSE NO- TOTALS t_,��9�
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway.map. �7 U),07 �
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
andthat o p of the same
has been paid.
Date
I
JUS - 2 X015 t
����� �C'
PRESCRIBED BY STATE BOARD OF ACCOUNTS , GENERAL FORE 110.101(1986)
MILEAGE CLAIM
t— Cl'pf
r �V I {t'
'rr
(GOVERNMENTAL ONIn
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEPARTMENT OR 1N9TODTI0N)
SPEEDOMETER
'nDATE FROM TO READING + AUTO NATURE OF BUSINESS MILES Q I4ILEAG S�•S
V POINT POINT START FINISH TRAVELED PERS
as r E
VC 5
(
-bl MSC..
41 1 �Io i:,
cc
,Wi
V
cc
AEM MCC
!.�^ er— L —
=IDIL ce
4-3.1
M- 4 C v
AUTO LICENSE NO. I TOTALS i
+ SPEEDOMETER READING columns are to be used only when distance between paints 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 leg a y due,after allowing allAt credits.-
and that-11O part of the same has been paid.
Dale uL Cr�` �� �_.�._� l'. 1 ..� ��1 u•
PMCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110.101 11986)
MILEAGE CLAIM � 1 01
kl
dri ffif)�YCYNA_
J5 ro
FT
TGOVEBNNENrAL tM
ON ACCOUNT OF APPROPRIATION NO. FOR i
[OFFICE,BOARD,DRARTLMfr OR 1NSTITITIION)
FROM TO RAD NG +ETFR AUTO HIIEAGE
ES
POINT POINT START FINISH NATURE OF BUSINESS TRAVELED
PER MILE
y_
Po 15
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ft _
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_) AUTO LICENSE NO_ TOTAL9 13
s
+ 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 t credits
and that no part of the same has been paid,
Date ✓ I=..—_�rti- --
JUN - 2 2015
J
1.
i
M-SCRIBED H7 STATE BOARD OF ACCOUNTS GENERAL FORK 110.IBI(1486)
S MILEAGE CLAIM 1�S k�
ro
j
[GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. d FOR i
t
' (OF,-ICC,BOARD,OE}AATIh7TT Op 1NST[TlR10N) i
DA
FROM TO SPEEDOMETER AUTO MILEAGE
READING .1. NATURE OF BUSINESS MILES 0
c
POINT POINT START FINISH i TRAVELED PER MILE
a
i=n IF
CC i, ✓u 15
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rvlfl -DF
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51-
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M
me
MCG ry GO Ll
CL .�
r
ms , ——
s--&8-
ai
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. � I�+�q2 J
r
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby cattily that the foregoing account is just and correct,that the amount claimed is le ally e,after aliowinq all just c dits,
and thao�partofthe same has been paid.
Date / 7
rJU
201501 4
i
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
6/2/15 Reimb Mileage 12/1/14-6/1/15 $ 448.60
Total $ 448.60
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$
$ 448.60
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-4 Reimb 4343000 $ 448.60 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
June 11, 2015
Signature
$ 448.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I