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Home My WebLink About260065 06/28/16 o CITY OF CARMEL, INDIANA VENDOR: 359285 ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $*******346.83* CARMEL, INDIANA 46032 2703 E LYNN ST CHECK NUMBER: 260065 ANDERSON IN 46016 CHECK DATE: 06/28/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4343000 REIM 241.65 TRAVEL FEES & EXPENSE 1082 4343000 REIM 105.18 TRAVEL FEES & EXPENSE i Voucher No. Warrant No. 359285 Simmonds, Valeska Allowed 20 2703 E Lynn St Anderson, IN 46016 In Sum of$ $ 346.83 ON ACCOUNT OF APPROPRIATION FOR 108 -ESE PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 1081-4 Reimb 4343000 $ 241.65 1 hereby certify that the attached invoice(s), or 1082-10 Reimb 4343000 $ 105.18 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 22, 2016 1P4WMVA" Signature $ 346.83 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund GENERAL FORM llo.lot 11986) PRESCRIBED BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM TO (Go NNENTALUNITI ON ACCOUNT OF APPROPRIATION,NO. FOR (ZiHICE,BOARD.DETARTl.DW oR iN5TTNr10N) - - SPEEDOMETER AUTO MILEAGE FROM TO READING + MATURE OF BUSINESS MILES C4 DA,,T''E^^ POINT START FINISH TRAVELED PERS _.]L POINT �I 0 ec -O£ , 5 Y-0 Or c DO MCC C MCC l- G MCL MCL- I yl- — ----'- -_ cc t IL- a TOTALS AUTO LICENSE NO. �1 ..y 1 + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or cfitcial 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 legall du 1,after aliowinq all j t credits and that no art o! the same has been paid. Date T q3�yo / CEIVED JUIN 2 2 2016 BY: r_ GENERAL FORD 110.lot(1906) PRLSCRIBCD BY STATC BOARD OF ACCOUNTS (� MILEAGE CLAIM To ' — , ON ACCOUNT OF APPROPRIATION NO. FOR EIINNENTAL U1111T IOF710E,BOARD.DEPARTbm(T OR INSTRIrriON) _ SPEEDOMETER AUTO 11I►-EAGE f FROM TO READING .)- NATURE OF BUSINESS IES d � ___ FINi9TRAVELED P DP AL�}' - POINT POINT STAR7 ff t C47 --- - 4f- 14ro _ EL <ry Q r' i 1 - -l�6t— MC.C- po� A �J Cr LL -- TOTALS 10 i sz . AUTO LICENSE NO. �� + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage Or official higlnvay.map. Pursuant to the prbvislOns and penalties of Chapter 156,Acts 1953,I hereby certify that the foregoing account is just and correct, that the amount claimed is leg 1y e,after allowing all j L credits and that n part fill dame has been paid. U Date `� VID UN 2 2 2016 I GENERAL FORD IIO.101(1906) pWE:RIaED BY STATE BOARD OF ACCOUNTS 1�1 ' MILEAGE CLAIMI I 1J{� �, _ r�1/r E-f1 _ '56 TOy (oovENNxeNrAL tn++n ON ACCOUNT OF APPROPRIATION NO. FOR i IOFFICE,BOARD,DE}ANTLm(r OR 1NSr[TUrfON) ' ---SPEEDOMETER AUTO AlILEAGE c FROM 1 TO READING .+- NATURE OF BUSINESS MILES 0 DATE� TRAVELED PER MILE FINISH f.r_ POINT POINT START y fY1LG�---- —i i is - , LC. —1 —,�c ' f G -- LI- v MCC, �C- _Z GL L - L 3 _Z CL a wick/ q- me y -- TOTALS V o V AUTO LICENSE NO-_ O t� + SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway.map. Pursuant to the provisions and penalties of Chapter 155,.4cls 11353,I hereby ceridy that the foregoing account Is just and correct, that the amount claimed is 1lelgally due,after allowing a just credits and that nopari of the same has been paid. � V Date &,A k�CEIVED JUN 22 2016 BY: GENERAL FORM 110.101(1906) PRESCRIBED'BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM TO (GevrRNHeNrAE UN IT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFi1CP,HOARD,DF1AATl.lr7lT OR)NSftTITTION) ---- SPEEDOMETFA AUTO AIII-EM'E ` FROM TO READING •t- NATURE OF BUSINESS MILES Q TRAVELED PER WLE DATE _ POINT POINT START FINISH - Gr; 1'h GL - 1 J� I o - 3 - • = 1 p -L1 ihG - _ i - m - y i �1 --- TOTALS I AUTO LICENSE NO. 1 -79 + SPEEDOMETER READING columns are to be used enly when distance between points cannot be determined by fixed mileage or official highway map- I 1 Pursuant to the provisions and penalties of Chapter 155,Acts 1953,I hereby ceriily that the foregoing account is just and correct, that the amount claimed is legally due,after allowing all just credits and thatoo�pa j i gf,11o le same has been paid. Dale Elf I Vil- c JUN 22 2016 GENERAL FORW 110.101(1995) PWCRISEa BY STATE BOARD OF ACCOUNTS MILEAGE CLAIM (GOVI7IH14ENTAL 1571t} ON ACCOUNT OF APPROPRIATION NO. FOR (OfiTCE,AOAAe,eF}AA7LmfT OA 1NSrlrlrTlON) _ SPEEDOMETER AUTO WUAG£ FROM TO READING •(- MILES Cd E 'nDATE NATURE OF BUSINESS TRAVELED PER MILE FINiSIi POINT POINT START Cl 1 s 1 J'� 9 LD L VVIE, I CL% -- 0A rt 'e --- —2to cz -Errcxv- cms--- TOTALS OqS L 55` AUTO LICENSE NO. Ljq + SPEEDOMETER READING columns are to ba used only when distance between points cannot he determined by fixed mileage or official highway.map. Pursuant to the provlslons and penalties of Chapter 155,Acts 1953,I hereby certify that the foregoing account Is just and correct,that the iI1mount claimed is legally due,after allowing all fns redils,- and that no part o1 thesamehas been paid. Date 6—,),6 W 1 l JUN 2 2 2016 BY: GENERAL FORM 110.101 119861 pw CR1aED DY STATE HOARD OF ACCOUNTS MILEAGE CLAIM 'S TO -� (GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR (OFFICE,BOARD.DUAR71. r OR 1NST[TIIIIONJ _ ---- SPEEDOMETER AUTO MILEAGE C FROM TO READING .t- NATURE OF BUSINESS MILES Q DATE TRAVELED PER�� [7 POINT POINT START FINISH -- -r-21 m ---� �+-1 •t,n FO �► C � 4 �-- n' ° 4 t4 1 I i 1 7 El-t- EEEEEE 2 L 1 -L ocM TOTALS AUTO LICENSE NO. Q + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by axed mileage or official highway.map. 5 Pursuant to the provisions and penalties of Chapter 155,Arils 1953,I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due,after allowingg aa just dils, and that no part Of Ilte same has been paid. Date JUN 22 2016 BY GENERAL FOR)+110.IBI 11986) PWCRIBED BY STATE HOARD OF ACCOUNT'S MILEAGE CLAIM ro (oovERNNeNrA1 tnuTl ON ACCOUNT OF APPROPRIATION NO._— FOR F'ME.BOARD.DEPAMUN17 ON itism FT)ON) SPEEDOMETER AUTO MILEAGE FROM TO READING ( MILES 6 DATE _ NATURE OF HU51NE56 TRAVELED POINT POINT START FINISH TW - 0 _ r-o u yvi u r'\CL aq _D cc. 1 H1 c _ _ L t M TOTALS —1�( AUTO LICENSE NO. _ _ 5x05 + SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or ofllcial 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 ' redits and that no part of the same has been paid. Date { K �%�XVED- LV N 2 2 2016 l BY: __