251251 11/04/15 CITY OF CARMEL, INDIANA VENDOR: 359285
ofl ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $*******455.68*
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 251251
9y�TON�. ANDERSON IN 46016 CHECK DATE: 11/04/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 224.53 TRAVEL FEES & EXPENSE
1082 4343000 231.15 TRAVEL FEES & EXPENSE
I.,
PRLSCAIa W 87 STATE a0AA0 OF ACCOUNTS GENERAL fOAY 110.101(19661
MILEAGE CLAIM
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TO yt:LiP�' •��7 dllvt n'"1 f�
TUMERNMEHTAL UNI'T1 ON ACCOUNT OF APPROPRIATION NO.'7 FOR
16MCE,80AAD,DEPAATMID"O8 INSTITUTION)
SPEEDOMETER
DATE FROM TO READING + AUTO MILEAGE
NATURE OF BUSINESST'RAAVELED f
POINT POINT START FINISH - PER MILE
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AUTO LICENSE NO. TOTALS -7t5
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+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. .1x �(�j l'O
Pursuant to the provislons and penalties of Chapter 155,Acts;1953,I hereby cerlify that The foregoing account is just and correct,that the amount claimed is legally due,after allowing all just credits
and that nopartof the same has been paid,
Dale
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CC., ED
OCA 28 2015
BY:
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FOAL 110.IBI 11906)
MILEAGE CLAIM
TO
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IGOVERNMENTAL UNIT) i ON ACCOUNT OF APPROPRIATION NO.' FOR
IOFFICC,BOARD,DEPART n"OR)Nsrairnom)
SPEEDOMETER
DATE FROM TO READING 1 WLES AUI EAGE `
NATURE OF BUSINESS TRAVELED
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POINT � POINT START FINISH 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.
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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 part same has been paid.
Date = � —ab
ue�� CEIVED
r OCT 2 8 2015
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PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FOAL 110.101(11166)
MILEAGE CLAoIMFS T
1al�S l M
( rnNif NrAL IJNn) ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE,BOARD,DEr,1LATMXIff OR 1NSTRUIION)
SPEEDOMETER
�DANE FROM TO READING + NATURE OF BUSINESS AUTO
�..� POINT POINT START FINISH TRAVELED PERS 4
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AUTO LICENSE NO. TOTAL4r
+ 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 fly due,after allowing all jus redits
and that no part of the same has been paid.
qA
Date
F�3JU=IVED
-OCT 2 8 2015
BY.
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PRESCRIBED 9Y STATE BOARD OF ACCOUN75 ; GENERAL FOAM 110.IDI 11905)
MILEAGE CLAIM
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[GOVERNMENTAL UNIn j
ON ACCOUNT OF APPROPRIATION No.; FOR
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(5F-,10E,HOARD•DE}ARTum OR 1NstmmoR)
SPEEDOMETER
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AUTO LICENSE NO. TOTALS F �1lSt�
+ 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 foregoir)g account is just and correct,that the amount claimed is legally due,aft r allowing just credits
and that part of the same has been paid.
Date
CEIVED
0`
OCT 2 8 2015
I BY:
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PWCRIRED BY STATE BOARD OF ACCOUNTS •� GENERAL FOAL Ito.101 11981)
MILEAGE CLAIM l c
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ERNNENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO.! FOR
(OFFICE,BOARD,DErA.RT EI T OR INS TTUr1ON)
FROM TO SPEEDOMETER AUTO UILEAGE
DATE READING + NATURE OF BUSINESS MILES (q c
- - POINT POINT START FINISH TRAVELED PER MILE
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AUTO LICENSE NO. TOTALS LS1.
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway.map. S 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 credits
and that no part of the same has been paid.
Date
tTZECEI 7ED
300� 0 C T 2 8 2015
BY:
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PRESCRIBED BY STATE BOARD OF ACCOUNTS - GENERAL FORM 110.10)(1980)
MILEAGE CLAIM
TO M S
t vENNUENrAL muD
ON ACCOUNT OF APPROPRIATION,NO. FOR
tOHICC,BOARD,DEPARTMU"Oa INSMIEION)
SPEEDOMETER
DATE FROM TO AEADINl3AUTO I.uLEAGE
+ NATURE OF BUSINESS MILES (y a
POINT POINT START FINISH TRAVELED PER
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AUTO LICENSE NO_ TOTALS ` So
+ 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 just dits.-
and that no p ri of the same has been paid.
DateFZECEIIV
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ED
OCT 28 2015
BY:
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PRESCRIBED 8Y STATE BOARD OF ACCOUNTS GENERAL FOAM IIO.181(1986)
('G MILEAGE CLAIM
(GOVERNMENTAL UNIT,
ON ACCOUNT OF APPROPRIATION NO. FOR
{OFFICE,BOARD.DETARTIMn'OR INS MMON)
DATE FROM TO HEADING + AUTO MILEAGE
POINT POINT START FINIS[{ NATURE OF BUSINESS TRAVELED PER MILE
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fyi_+its watn�tar
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ry) _
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AUTO LICENSE NO. TOTALS
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+ 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 aliowing all just edits.
and khatnopart of the same has been paid.
Date=1F
CSTD
OCT 2 8 2015
VOL
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PWCIfIBED BY STATE BOARD OF ACCOUNTS GENERAL-FORM NO.1010"6)
MILEAGE CL IM
(GOVERNMENTAL UNITI ACCOU T F APPROPRIATION NO. FOR
(OFFICE„BOARD,DEFARn4HT OR INSEnTIION) j
FROMTO SPEEDOMETER I AUTO MILEAGE
DATE HE NATURE OF BUSINESS MILES ® t
2P-15�— POINT _ POINT START FINISH TRAVELED PER MILF
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y7 - t t I
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AUTO LICENSE NO. TOTALS
+ SPEEDOMETER READING columns are to be used only when distance between points cannot be determine d by fix d Ile�ge or official highway.map. 1
i
Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby certify that the loregoirlg acc unt is ju a d correct,that the amount claimed golly due,after allowing just credits.-
and
redits.and that no pari tfye sa'Ta'tas_bpen paid.
I/ �Y�n
Date � � .
i
A
OCT 2 $ 2015
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
10/28/15 Reimb Mileage 6/1 - 8/7/15 $ 231.15
10/28/15 Reimb Mileage 8/7- 10/20/15 $ 224.53
Total $ 455.68
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.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of$
$ 455.68 j
' I
ON ACCOUNT OF APPROPRIATION FOR
I
108 -ESE
j I
PO#or INVOICE NO. ACCT XTITLE AMOUNT Board Members
Dept#
1082-10 Reimb 4343000 $ 231.15 1 hereby certify that the attached invoice(s), or
1081-4 Reimb 4343000 $ 224.53 bill(s)is(are)true and correct and that the
materials or services itemized thereon for
i which charge is made were ordered and
received except
October 28, 2015
Signature
$ 455.68 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
I