188521 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
's 0 CHECK AMOUNT: $116.20
CARMEL, INDIANA 46032 2703 E LYNN ST
ANDERSON IN 46016 CHECK NUMBER: 188521
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343000 REIMB 116.20 TRAVEL FEES EXPENSE
J
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENF.RALFOBId NO. 101 (]9867
MILEAGE CLAIM (Yl
To
(GOVERNMENTAL uNM ON ACCOUNT OF APPROPRIATION NO. FOR
tOMCE, BOARD, DEP&RTV Eh OR INSriMIOH)
SPEEDOMETER iiTRAVEISED il'R GE
DATE FROM TO I READING c
�fI T POINT START F[NiSH NATURE OF BUSINESS
POINT MILE
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7M4 MLC
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AUTO LICENSE NO, TOTALS L 50
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 1953, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just edits
end that no pmt Of the Sam,, as been paid.
Date (V� J L 0 -1 0
1��0
BYo.......................
PR1!SCR18tD HY STATE BOARD OF ACCOUNTS GENERAL FORW 14O- 101 (19887
MILEAGE CLAIM Q S t M M
(GOVERNMENTAL UNM ON ACCOUNT OF APPROPRIATION NO- FOR
(Oi7Gp, HOARD. DEPARTmua OR lKsrm) :1014)
SPEEDOMETER
DATE FROM TO BEADING DSIUITE3 11II EAGE r
NATURE OF BUSINESS
2d POINT POINT START FINISH TRAVELED Ply MILE
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AUTO LICENSE NO, TOTALS s.J i "lQ
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. 571 W
L ursuant 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, fter allowing all just Odits
and that (n��o part of the same has been paid.
Date V
JUL
4
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
6130110 Reimb Mileage 6117 711110 116.20
Total 116.20
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
116.20
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
1 or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
Reimb 4343000 116.20 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
29 -Jul 2010
Signature
116.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund