HomeMy WebLinkAbout196101 03/29/2011 CITY OF CARMEL, INDIANA VENDOR: 359285 Page 1 of 1
ONE CIVIC SQUARE VALESKA SIMMONDS
CARMEL, INDIANA 46032 2703 E LYNN ST CHECK AMOUNT: $133.83
ANDERSON IN 46016
CHECK NUMBER: 196101
CHECK DATE: 3129/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4343000 133.83 TRAVEL FEES EXPENSE
PRESCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NC. IQI 11M0
MILEAGE CLAIM 2� P{` n f
ro V�, J(�
(GOVERNMENTAL UNIT? ON ACCOUNT OF APPROPRIATION NO. FOR
(OF710E, BOARD. DEPARTMENT OR INSnrUTION)
DA TX FROM TO S READNG AUTO f--LE W OE
POINT POINT START FINISH NATURE OF BUSINESS TRA fiD Cdi t
r I
MCA-
11 2
r
Q
e.
_i6 M �G
1h M
f4C
L
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AUTO LICENSE NO- TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is le ly a, after aliowing Must credits.
and that no r parl of the same has been paid,
Date L. 1 7
MAR 2011
BY:
PRESCRIR ED BY STATE BOARD OF ACCOUNTS GENEIIAL CORM NG. 101 tm&)
MILEAGE CLAIM
TO Q les k a m` 'Y�
(GOVERNMENTAL UNIT)
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD, DEPARTMENT OR INSrMirlog)
FROM TO SPEEDOMETER AUTO WUAGE
DATE HEADING
Z a PORJT POINT START FINISH NATURE OF BUSINESS TRA MILE
PER MILE
MCC A
e
_l
LL
tr1
1 L I
A CL
AUTO LICENSE NO_ TOTALS
SPEEDOMETER READING columns are to be used only when distance between points cannot he determined by fixed mileage or official highway map.
Pursuant to the provisions and penalties of Chapter 155, Acts 1953, 1 hereby cartily that the foregoing account is just and correct, that the amount claimed is legally due, after atiowing all just credits
end thaJ�rTi ja�t of the same has been paid. f�
Date y ff 1 J O
Lj it
MAR X02011
BY:
PMCRIBED BY STATE BOARD OF ACCOUNTS GENERAL FORM NO. IPI (1W$)
MILEAGE CLAIM e r�� 4 q
(GOVERNMENTAL UNI1T l
ON ACCOUNT OF APPROPRIATION NO. FOR
(OFFICE, BOARD. DLP"TMDR OR INSTMJTION]
FROM TO SPEEDOMETER AUTO UrLEAGE
DATE READING
POINT POINT START FINISH NATURE OF BUSINESS MILES
TRAVELED PER WLE
M
1
s
rn"
gr-
ti
i Pi
AUTO LICENSE NO. TOTALS rr I S
f SPEEDOMETER READING columns are to be used only when distance between points cannot be determined by fixed mileage or official highway map. I9/
Pursuant to the provisions and penalties of Chapter 155, Acts 1453, I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, sr allowing all just credits
and that no part of the same has been paid.
n
Dale
Li
MAR 1 0 2011
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
314/11 Reimb Mileage 113 3/4/11 133.83
Total 133.83
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$
133.83
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Dept
1081 -4 Reimb 4343000 133.83 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
24 -Mar 2011
Signature
133.83 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund