181387 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
1 '1. ONE CIVIC SQUARE VALESKA SIMMONDS
1 i�
a CARMEL, INDIANA 46032 2703E LYNN ST
CHECK AMOUNT: $121.00
ANDERSON IN 46016 CHECK NUMBER: 181387
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 121.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 1NG. 1P1 t19BB)
MILEAGE CLAIM I 1 051e S Q 5
O V Q C`�
(GOVERNMENTAL UNIT) ON ACCOUNT OF APPROPRIATION NO. FOR
t004100. BOARD, OEPART OWT GB 1NSTrr rr1GN1
SPEEDOMETER AUTO MILEAGE
DATE FROM TO C READING MILES
2.0 POINT POINT I START NATURE OF BUSINES6 TRAVELED PERK
4 ,71 'tai .11 id 1 1 I�111M
AA Min
1� 1
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I Mill NM
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AUTO LICENSE NO. TOTALS r, 5 V
•SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. d V l 5 E Nip
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, l hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all j credits
'end that no part of the same has been paid.
Date 43,,,fyy,*
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tt JAN 0 5 -,.010
air
PRESCRIBED BY STATE BOARD Oi ACCOUNrs V
GENFAAL FORM 1+0. ID) IL985)
MILEAGE CLAIM 0 i e S fj� c J (GOVERNMENTAL UNITI f d�
ON ACCOUNT OF APPROPRIATION i ION NO- FOR
(OFFICE, BOARD, DEPA id:ENT OR ]NSTrriniox)
DATE FROM TO li BEEAOING T I AUTO MILEAGE
z� �t�
POINT POINT START 111= {Ik NATURE OF BUSINESS MILES i4 TRAVELED PER MILE
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MIMI
AUTO LICENSE NO. TOTALS UMW' .SS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map- L/ .120i
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, I hereby certify that the foregoing account is lust and correct, that the amount claimed is legally due, after allowing all just •edits
end that no part of the same has been paid. l Yzem/G44- D V as
m,,,_,,,
:_,„JAN 0 5 2010
BY-
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM 110. 401 119067 le MILEAGE CLAIM T d
TO a (GOVERNMENTAL inm
ON ACCOUNT OF APPROPRIATION NO. FOR
(OF:7CE, BOARD, DEPAM:ENT OR lNSrirUrlO$J
DATE lr
FROM TO I I S READING
AUTO MILEAGE C yi POINT INT PO' START FINISH NATURE OF BUSINES6 MILES d TRAVELED
PER MILE
Al_ _L f t [a r cd e-+ c_ d I���I IR1
i -la •1 ctici Ct- 1- G'
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i 9 (3- ica. rhOe pr)F- hoc
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11 a 3 1 cifo e.+ r-o G
AUTO LICENSE NO. TOTALS I f
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway. map. ;50, l00
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.1 any after allowing all lust edits
end that no a same has been pal.. Jn„ /hy/l al
Date l
I r
Li c r
t_90 Lit3L17(t)°Lif N irmi •••-1 iv, r
c) VI J 0 5 1010
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
Reimb. Mileage 11/6 12/17/09 121.00
Total 121.00
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
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016 �4
In Sum of$
121.00
ON ACCOUNT OF APPROPRIATION FOR
a
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept it
—4846- Reimb. 4343004 121.00 I hereby certify that the attached invoice(s), or
03/ 4 7 1 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
7 -Jan 2010
1 --2/ 01
Signature
121.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund