HomeMy WebLinkAbout187028 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
0 ONE CIVIC SQUARE VALESKA SIMMONDS CHECK AMOUNT: $70.50
CARMEL, INDIANA 46032 2703 E LYNN ST
`o ANDERSON IN 46016 CHECK NUMBER: 187028
CHECK DATE: 6123/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 70.50 TRAVEL FEES EXPENSE
PRESCM1120 BY SIATE BOARD OF ACCOUNTS GZZIFIIAL FORM NO. w) (15867
MILEAGE CLAIM �fQ�� �q
TOE.— I -N
(GOYEANM6NrhL ntUT7
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTIMT OR 7N4TITUTION)
SPEEllOMETFII
DATE FROM TO READWG AUTO MILEAGE
NATURE OF BUSINESS MILES a c
POINT. POINT START FINISH TRAVELED PER MILE
CL
VI F2 j'tL r Cl
S
rh cc_ 0 AF w�_
5
Fo e
Cam-
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-7- o �.o I I ---1
AUTO LICENSE NO. TOTALS I�
SPEEDOMETER READING columns are to be used only when distance between points cannot be,detennined by fixed mileage or official. highway map. v 23
Pursuant to the provisions and penalties of Chapter Acts 1953j hereby csrtify.thal the foregoing account is just and correct, that the amount claimed is legally due, after dliawing all jiupj credits
Brtd tha� part of the same has been paid.
Date
'7
JUN 4 ZD
l CL-1
t
PRESCRIR.ED BY STATE BDARD OF ACCOUNTS GENERAL FORM NO. 101 ORF8
MILEAGE CLAIM
TO
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OPi3CC, BOAAI), DEPAAT},fitiT OR INATITUTIgN7
SPEEDCMETFR
I)A FROM TO READING AUTO MILEAGE
NATURE OF BUSINESS MILES t
POINT POINT STAPT FINISH I TRAVELED PER MILE
pue
MY
AUTO LICENSE NO. TOTALS
SPEEDOMETER READING columns are to be used only when distance hhatween points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter Acts 1953, 1 hereby cerlify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just, credits
'arid that no. part of the same has been paid. Qj e
Date
'77 JUN 0 4 2010 w
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
5128110 Reimb Mileage 5/3 5128110 70.50
Total 70.50
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
359285 Simmonds, Valeska Allowed 20
2703 E Lynn St
Anderson, IN 46016
In Sum of
70.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 70.50 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
17 -Jun 2010
Signature
70.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund