182999 03/03/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
CHECK AMOUNT: $61.00
CARMEL, INDIANA 46032 2703 E LYNN 57
ANDERSON IN 46016 CHECK NUMBER: 182999
CHECK DATE: 313!2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1061 4343000 61.00 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM I10. 101 11"
MILEAGE CLAIM i a St
TO do
(GOVERNMENTAL UN1T1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPART D(T OR 1NSTnJTION)
SPEEDOMETER
DATE FROM TO READING MILES 0 MILEAGE C
20 NATURE OF BUSINESS
POINT j POINT START FINISH TRAVELED PER MILE
PA
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m CG
L rnL
AUTO LICENSE NO. TOTALS L C`
U
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Q0 5 t 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 aliowing all ust creditsEp
and that ea has been paid. llUUff r v
Date Q x yj �rJ t 1/j/f
T r
PR[SCIi18CD By STATE BOAArI OF ACCOUNTS y- /IV
MILEAGE CLAIM GENERAL FORM 1t0. ICL (1986y L L M
TO
00VORMENTAL UNITt
ON ACCOUNT OF APPROPRIATION NO. FOR
(6y, ZE, HOARD, DuAATwxKT OA UtsTrruT1oN)
SPEEDOMETER AUTO MILEAGE
DATE FROM TO I READING NATURE OF BUSINESS MILES I
rte, POINT POINT START F]NiSfI TRAYFLHA PER MILE
Li
Lq
rn� -oc
°iU
L
L
C C
v rr.� r ��r it i
VI
io
G
i t=om G
AUTO LICENSE NO. TOTALS I 5u
PEEDOMETEA 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 iy due, after aliowing all I'trst credits,-
end that no,part of the same has been paid.
D ate
FEB C 5 2010
BY:
r
A6000NTS 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
2/1/10 Reimb. Mileage 1/4 2/1/10 61.00
Total 61.00
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
61.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb. 4343000 61.00 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
25 -Feb 2010
Signature
61.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund