191837 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
0 ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $215.50
ANDERSON IN 46016 CHECK NUMBER: 191837
CHECK DATE: 1111012010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 REIMB 215.50 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL PORW 14C. IN (1986)
MILEAGE CLAIM
To �e Ski Irn rn&
(GOVERNMENTAL Mr,
ON ACCOUNT OF APPROPRIATION NO. FOR
(OMCE, BOARD, DEPARTMNIT OR INSETTUTION)
DATE FROM TO SPEEDOMET AUTO MILEAGE
POINT POINT START FINISH NATURE OF SUSINE56 TRAVELED
PER MILE
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AUTO LICENSE NO. �h
TOTALS sly+
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. t
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 just c redits
end that no part of the same has been paid.
Date r 6 O�
NOV 3, 201
I
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL rOR1d NG- 101 [1906)
MILEAGE CLAIM a l e sl�� n fl'�i
[GOVERNMENTAL UNE) ON ACCOUNT OF APPROPRIATION NO. FOR
[OF. BOA A9, DEPAATWEKT OR INSrrruilON)
$PEEDOMETEA AUTO MILEAGE
DATE FROM TO READING
NAT[IRE OF BUSINESS MILES Q
GOT POINT START FINISH
TRAVELED PER MILE
/CJ
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C, S
L
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1 r
I
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. r
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 du fter aliowing all just edits
and that no part of the a has been paid. f
Date
Z y vv�
NOV 0 3 7010
BY:
AAr5CR19[D BY STATE BOARD OF ACCOUNTS
GEN[RAL FORM tic. IN 0"n
MILEAGE CLAIM
TO ��Sj ��i11'lrUn S
IGOVVRNMENrAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
{OfTICE. BOARD. DEPARTMENT OA tNSTMTrION)
SPEEDOMETEIL AUTO MILEAGE
DATE FROM To BEADING NATURE OF BUSINESS MnES
POINT POINT START FINISH TRAVFLED PER MILE
�t 2 :1 c� Ain
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AUTO LICENSE NO_ r
TOTALS (02
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway. map. L
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 d after allowing all A t credits
and that no part oft ame been paid.
Date J 2 t G
Mu
NOV 0 3 1010
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
10/25/10 Reimb Mileage 917 10/22/10 215.50
Total 215.50
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$
215.50
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE N0. ACCT #/TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 215.50 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
4 -Nov 2010
Signature
2.15.50 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund