183679 03/25/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $123.00
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 183679
CHECK DATE: 312512010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 123.00 TRAVEL FEES EXPENSE
7
S�
PRESCRIBED BY STATE HOARD OF ACCOUNTS GG(F.RAL FORM NC. ]W 11986)
MILEAGE CLAI
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION ND_ FOR
(OF, BOARD, DEPAATNMff OR INSTMJTIONI
SPEEDOMETER
Tr FROM TO I READING AUTO NiLEAGE
FINISH NATURE OF BUSINESS ISLES
POINT POINT START t
TRAVELED PER
r
(i
IN
ei-
M
VW
c
Nl
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. f��
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 cre
-end that n3d of�tls g sarn has een paid.
Date
B7a.......................
PRESCRIBED BY STATE BOARD OF ACCOUNTS
GENERAL FoRa nc. lel (isesl
MILEAGE CLAIM dh
Tp
(GOVERNMENTAL UMT1
ON ACCOUNT OF APPROPRIATION NO. FOR
(OP710E, BOARD, DEPARTWZ)a OR INS ITU11ON)
FROM TO SPEEDOMET£H AUTO MILEAGE
DATE READING
POINT i POINT START FINISH NATURE OF BUSINESS �VELED
PER MILE
u n�f L
GlM
rvm
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.
Pursuant to the provisions and penalties of Chapter 155, Acts 1853 „I hereby cattily that the foregoing account is just and correct, that the amount claimed is legally due, after allowing just c edits
end that no rt of the same has been paid.
-Date
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
3/12110 Reimb. Mileage 2/1/10 3112/10 123.00
Total 123.00
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
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of$
123.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb. 4343000 123.00 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 -Mar 2010
Signature
123.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund