HomeMy WebLinkAbout252130 12/02/1 5 .Coq
`� ._,,f CITY OF CARMEL, INDIANA VENDOR: 359285
1 'a. CHECK AMOUNT: $*—....50.02"
.j; ® :� ONE CIVIC SQUARE VALESKA SIMMONDS
;4 CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 252130
,,,_aN�� ANDERSON IN 46016 CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 50.02 TRAVEL FEES & EXPENSE
C'4
NOV 2 0 215
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' GENERAL FOA1111C.IBI 11986) t\
PRLSCRIRED BY STATE BOARD OF ACCOUNTS BY:-- ,
MILEAGE CLAIM U v (�S SC lYt J\
To
c (GOVERNMENTAL U11111 ON ACCOUNT OF PROPRIATION NO. FOR
(OFFICE,BOARD,DEPART1tEHT OR 1NsrrrunoN)
- ---- SPEEDOMETER AUTO MILEAGE
FROM To READING + MILES d �
�D NATURE OF BUSINESS TRAVELED
POINT POINT START FINISH PERS
Qr to C-�
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AUTO LICENSE NO.
+ 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 IOTegoing account is just and correct, that the amount claimed is leg fly due,alter aliowing all just redits
and that no part o Ilie Vas been paid.
Date '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
11/19/15 Reimb Mileage 10/28 - 11/18/15 $ 50.02 �I
Total $ 50.02
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
120
Clerk-Treasurer
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of$
$ 50.02
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or Board Members
Dept#
INVOICE NO. ACCT#/TITL AMOUNT
1081-4 Reimb 4343000 $ 50.02 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
November 23, 2015
Signature
$ 50.02 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund